020117 STALE DATED WARRANT 2_REDACTED.PDF

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: El Duplicate or • Stale-Dated (definitions are on page 2)
STATE OF ARIZONA Note: Numbers on this form correspond to numbers on the
COUNTY OF MARICOPA Instruction sheet which is page 2 of this form.
Cathy Sanchez (1), being first sworn, upon oath deposes and says:
Name/Clamant
On or about May 17, 2012 (date)(2) a warrant/check was issued to the
named person/entity in the amount as stated below. Such warrant/check was
either never received or was subsequently inadvertently lost or destroyed and there is
no reasonable probability of its being found or presented for payment, or it was not
presented for payment within one year after the date of issuance.
Therefore, under penalty of perjury, claimant hereby affirms that this claim is correct
and the amount shown is due and owing, and the applicant requests that a replacement
Crterva\--oorce.. IN(72-0ti) F-ANAOcx , Lks.
warrant/check be issued to him/her in the sum of $2,733.44 .(3)
Signed: La_41441 (4)
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
(5) _ Subscribed and sworn to before me this Z 0" day of j'crrl ("Ch, y 20 (2 .
NOTARY PUBLIC NANCY M JONES
Notary Public - Arizona
My commission expires: Maricopa County
• My Comm. Expires Aug 23, 2019
(seal)
Warrant/Check Number 767072
(if known) (6)
Original Date of Issue 5/17/2012
(if known) (7)
Reason for original issue of Warrant/Check (8):
O Payroll
O For Services or Goods furnished
Treasurer's refund/payment --va \-\cn 4e a. ex-NE*1 <-6
O Other:
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.cloc
Revised April 2015 A.R.S. 11-632 & 11-644

Disbursement Detail I 433686 Page 1 of 1
Maricopa County Treasurer
Disbursement Detail
Check Number: 767072 Request Date: 5/16/2012
Issue Date: 05/17/2012 Requester: PANOPIOH
Current Status: STALE Request Status: APPROVED
Medium: CHECK Reference: SLIP 201200455
Reissued To: Approval Date: 5/17/2012
Exception NO EXCEPTION Approver: CORDOVAD
Type: REFUNDS Destination: MAIL
Reissued From:
Payee GL Account Number Amount
CAPITALSOURCE BK FBO AEON FINANCIAL LLC 30050000 $2,733.44
233 SOUTH WACKER DRIVE
CHICAGO IL 60606
Check Total: $2,733.44
Stub Information
OP Redemption refund
PARCEL CP CP AMOUNT PARCEL CP OP AMOUNT
105-32-055 09002320 $1,853.87 108-20-096 10002858 $396.57
121-03-080 10004993 $483.00
Status Date Status Description User
5/17/2012 READY CORDOVAD
5/17/2012 SELECTED JOHNSONB001
5/17/2012 ISSUED JOHNSONB001
6/3/2013 STALE JOHNSONB001
file:///CiUsers/sanchezc004/AppData/Local/Temp/radl4CE4.html 1/20/2017

Maricopa County Treasurer's Office 108-20-096 1 1/20/2017 12:01:14 PM
Parcel Number: 108-20-096 1
Tax Summary Tax Details Valuations Activity Summary
Tax Due Impounds Fees
Tax Year I Clerk Comments UserNa
2011 257 5/2551 2 CK CASH STORE CALD SOMEONE OTHER THAN PAYEE WANTING TO CASH CK NO RiGGIN
R.eciernption Tax Bill...
Staterrie.nt...

Maricopa County Treasurer's Office 121-03-080 2 1/20/2017 12:01:27 PM
121-03-080 2
Fie Help
Parcel Number: 121 -03-080 2
Tax Summr j Tax Details Valuations Name/Address Legal Description Activity Summary
Tax Due Impounds Resolutions Fees
UserNa
2015 142 SP# 64720_8/8/16 ROYSE
2015 142 SP# 64720...1-IAND RES BEING PROCESSED...8/8/16 ROYSE
2015 142 SP# 64720...CTR BEING PROCESSED...8/12/16 ROYSE
2015 142 SP# 64720_CTR. COMPLETED...CLOSED...8/25/16 ROYSE
2011 009 TRANSFER FD27 TO PAY 2010 CP- 05/16/12 GOND,
2010 257 5/25512 OK CASH STORE CALD SOMEONE OTHER THAN PAYEE WANTING TO CASH CK Nu RIGGIN

Maricopa County Treasurer's Office 105-32-055 3 1/20/2017 12:01:01 PM
File Help
Parcel Number: 105-32-055 3
Tax Summary Tax Details Valuations Name/Address Legal Description Activity Summary
Tax Due Impounds Resolutions Comments Fees
Tax Year Clerk Comments I UserNe
2011 384 DELINQ MAILER 12/2011 PO RETURN: VACANT SOBIEE
2011 384 BILLING 09/2011 PO RETURN SOBIEE
2011 384 DELINQ MAILER 06/2011 PO RETURN: SOBIEE
2011 142 HS# 31751... 5/16/12 ROYSE
2011 142 HS# 31751...CTR REQUESTED... 5/16/12 ROYSE
2011 257 5/25512 CK CASH STORE CAW SOMEONE OTHER THAN PAYEE WANTING TO CASH CK NO RIGGIN
2011 142 HS# 31751...CTR COMPLETED..CLOSED... 5/29/12 ROYSE
2010 384 BILLING 09/2010 PO RETURN: UNCLAIMED SOBIEE
2010 384 DELINQ MAILER 12/2010 PO RETURN: VACANT SOBIEE
2009 384 PO RETURN 09/2009 BILLING SOBIES.
2009 384 PO RETURN 06/2010 DELINQ SOBIEE
2007 384 PO RETURN 09/07 BILLING SOBIEE
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