101916 STALE DATED WARRANTS 1.PDF

MARICOPA COUNTY
Department of Finance
301 West Jefferson, Ste 960
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
Date: October 4, 2016
To: Clerk of the Board
From: Beth Brown
Department of Finance
Subject: Affidavit — Notice of Claim
Please find attached Affidavit for stale dated warrant to be included on the next
available Board Agenda.
• The attached item has been researched to ensure that warrant in question
has not been cashed or previously re-issued.
• The original warrant has a void/stale date/stop payment done.
Please call me at 506-1329 if you have any questions. Please return the approved
Affidavit to my attention in the Department of Finance, Suite 960.
Thank you.
Re: Equity Title Agency
OCT 2016
CLER

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
COUNTY OF MARICOPA numbers on the Instruction sheet which is
Page 2 of this form.
Equity Title Agency (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 06-Jul-2015 (date)(2) a warrant/check was issued to the
above 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
warrant/check be issued to him/her in the sum of $248.06 .(3)
AZ
Signed: (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 r/divarn to before me this 9ç? day of SZp/=-- 204a
Christinna M. Flynn
Notary Public
My commission expires: Maricopa County, Arizona
My Comm. Expires 03-05-17 (seal)
Warrant/Check Number 827350
(if known) (6)
Original Date of Issue 06-Jul-2015
(if known) (7)
Reason for original issue of Warrant/Check (8):
0 Payroll
0 For Services or Goods furnished
Treasurer's refund/payment overpayment of taxes
CI Other:

MARICOPA COUNTY TREASURER JPIVorgan Chase Bank, N.A.
CHARLES "HOS" HOSKINS, COUNTY TREASURER ACFI PHOENK FUT 122100024 AZ 82'7350
SERVICING BANK ACCOUNT 0-211 .221 82735-0 '
PAY 0766/2015
248 Dollars And 6 Cents
$248.06
TO THE ORDER OF
EQUITY TITLE AGENCY INC
7975 N-HAYDEN RD STE C280 MARICOPA CHECK VOID COUNTY ACTER 365 DAYS
TREASURER
SCOTTSDALE -AZ 85251_ CHARLES "HOS" HOSKINS, COUNTY TREASURER
MEMO
4a4•014' 13, I404.,441,
AUTHORIZED SIGNATURE
08 2 7 3 SOH' / 22 1000 241:
./ 9000 / 40 10
•
THE ATTACHED CHECK IS IN PAYMENT OF ITEMS DESCRIBED DETACH AND RETAIN THIS-STATEMENT
DATE -BELOW. IF NOT CORRECT PLEASE NOTIFY US PROMPTLY. NO RECEIPT DESIRED.
\ DESCRIPTION
Refund Reason: Overpayment of property AMOUNT
Parcel 173-35-337 taxes
'ESCROW/FILE: 01719769 017 EW3
SELLER/BUYER: KIRKLAND-MYERS/CRAIG
PROPERTY 'ADDRESS: 4620 N 68TH ST #127
SCOTTSDALE AZ
07 06 2015 827350 SLIP 201500438
'LAND CLARKE M20845 40498895 CHECK TOTAL: $248.06
MAR1COPA COUNTY TREASURER
CHARLES "HOS" HOSKINS, COUNTY TREASURER
SERVICING BANK ACCOUNT 827350

EQUITY
TITLE AGENCY
A Member Family of the of Companies Ong e Coast Title
Douglas Bergner
St Vice President
Escrow Administrator
Raining Director
Maricopa County Treasurer
RE: Warrant Number 827350
To whom it concerns,
Barb Seaton has authority to sign for Equity Title Agency in regard to the matter referenced above.
Sin
Doug Bergner, SVP
13847 N. Northsight Blvd. • Ste. 101 • Scottsdale, AZ 85260
Tel.: 480-368-5458 • Fax: 480-315-8366 • www.eta-az.com