101916 STALE DATED WARRANTS 2.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
ED
4 2016
fk/IA/ I
CLERK BOA OF PEPISOFIS
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Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: El Duplicate or el 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
Dade 2 of this form.
Equity Title Agency (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 04-Jun-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 hi>herin the sum of $ 376 .91 .(3)
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 74/97 to before me this _______day of <gp/---- 204Q.
NOTARY PUBL
My commission expires. Christinna M. Flynn
Notary Public
Maricopa County, Arizona (seal)
My Comm, Expires 03-05-17
Warrant/Check Number 825717
(if known) (6)
Original Date of Issue 04-Jun-2015
(if known) (7)
Reason for original issue of Warrant/Check (8):
O Payroll
O For Services or Goods furnished
Fl Treasurer's refund/payment overpayment of taxes
O Other:

AtIARICOPA COUNTY TREASURER JPMorgan Chase Bank, N.A.
CHARLES "FIOS" HOSKINS, COUNTY TREASURER ACH PHOENIX, R/T 122100024 AZ 825717
SERVICING BANK ACCOUNT 91-2/1221 825717
PAY 00-W412015
.1T./4 a •
376 Dollars and 91 Cents
$376.91
TO THE ORDER OF
EQUITY TITLE AGENCY INC CHECK VOID AFTER 365 DAYS
7975 HAYDEN RID ,STE C280 MARICOPA COUNTY TREASURER
S COTTSDALE AZ 85258 , CHARLES "HOS" HOSKINS, COUNTY TREASURER
AUTHORIZED SIGNATURE
11'8 2S ? ? II' I:1 2 2 10 0 0 241: , '1 000 11,0
THE ATTACHED CHECK IS IN PAYMENT OF ITEMS DESCRIBED DETACH AND RETAIN THIS STATEMENT —
DATE-- BELOW.-IF NOT CORRECT PLEASE NOTIFY US PROMPTLY. ts10 )RECEIPT DESIRED.
DESCRIPTION
Refund Reason: Overpayment of property taxes AMOUNT
Parcel 214-02-597 Tax Year 2014
FILE NUMBER 01720375-01 EW
06/04/2015 825717 SLIP 201500364
HARLAND CLARKE M20845 40498895 CHECK TOTAL: = $376.91
MARICOPA COUNTY TREASURER
CHARLES "HOS" HOSKINS, COUNTY TREASURER 825717
SERVICING BANK ACCOUNT

EQUITY
TITLE AGENCY
A Member Family of the of Cz Orange Impanies Coast Mir
Douglas Bergner
Si: Vice President
Escrow Administrator
7i.aining Director
Maricopa County Treasurer
RE: Warrant Number 825717
To whom it concerns,
Barb Seaton has authority to sign for Equity Title Agency in regard to the matter referenced above.
Doug Bergner, SVP
13847 N. Northsight Blvd. Ste. 101 • Scottsdale, AZ 85260
Tel.: 480-368-5458 • Fax: 480-315-8366 • www.eta-az.com