090716 STALE DATED WARRANTS 1 - FINANCE_REDACTED.PDF

MARICOPA COUNTY
Department of Finance
301 West Jefferson, Ste 960
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
Date: August 8,2016
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: Maria Gutierrez

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: El Duplicate or 1Stale-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
nape 2 of this form.
MARIA GUTIERREZ (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 20-Feb-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 is,ddcl to him/her in the sum of $ 424.96 .(3)
Signed: ailLi •2 /2 (4)
Note; Pie 'e attach a c 'e warrant/check if available and/or any other
evidence ti at a warrant/ch tk was originally issued.
(5) Subscribed and swojrn to before me this .0 1 day of 20 //, .
NOTARY PUBLIC CIERA JACKSON
NOTARY PUBLIC • ARIZONA
My commission expires: My Maricopa Commission County Expires
01-1-10 1413-0 ( (6 Nth*, Pols al)
Warrant/Check Number 820215
(if known) (6)
Original Date of Issue 20-Feb-2015
(if known) (7)
Reason for original issue of Warrant/Check (8):
LI Payroll
El For Services or Goods furnished
? Treasurer's refund/payment Parcel 10222559, tax year 2014
El Other:

Maria Gutierrez
11 July 2016
Maricopa County Department of Finance
Attn: Beth Brown
301 W Jefferson, Suite 960
Phoenix, AZ 85003
RE: Notice of Claim for replacement of Check 820215
Dear Ms. Beth Brown and board of supervisors if applicable:
I am asking for the county re-issue check/warrant 820215 dated 02/20/2015 for the amount of
$424.96 that was a result of an adjustment in tax liability for parcel 102-22-559 8. I did not cash
the check because it got lost in my home while I was going through a lot of medical treatments
and surgeries. As I was going through a pile of medical documents it was when I discovered that
the Treasures office did follow through and issued a refund. At this point in time it was June
2016 and per the checks disclaimer it now was void. If you have any further questions, please
feel free to reach out to me or my son Homer Gutierrez at
Enclosed: Original Check & Stub
Affidavit/ Claim Form
Check resolution letter

Charles "Hos" Hoskins, Treasurer
301 West Jefferson St., Rm. 100
Phoenix, Arizona 85003
Maricopa County Phone: (602) 506-8511
Fax: (602) 506-1102
Treasurer h ttp://treas r er.11112ricopa.gov
February 19, 2015
MARIA GUTIERREZ
Subject: Parcel Number: 102-22-559 8
Resolution Number: 04795
Dear Taxpayer:
We have been notified by the Maricopa County Assessor's Office that a tax resolution
has been approved, adjusting the tax liabiiity on the above-captioned parcel for the
2014 tax year. This has resulted in an overpayment in the amount of $424.96.
Enclosed is your corrected tax statement indicating the new parce! tax liability.
Enclosed you will find your refund in the amount of $424.96.
Should you have any questions regarding this notice, please contact our office at
(602) 506-8511.
Resolution Section
Enclosure
For office use only:
CTX REFUND
2014,33.04795.05

JI3 Morgan Chase Bank, N.A.
MARICOPA COUNTY TREASURER PHOENIX, AZ 820215 t.
CHARLES "HOS" HOSIUNS, COUNTY TREASURER ACI-I PVT 122100024 820215 !
SERVICING BANK ACCOUNT 91-2/1221
Oi20/2015 8
PAY
424 Dollars and 96 Cents 8424.96
TO TI-IF ORDER OF
MARIA GUTIERREZ CHECK VOID AFTER 365 DAYS
MARICOPA COUNTY TREASURER
CHARLES "HOS" HOSKINS, COUNTY TREASURER
16, /1\71
MEMO AUTHORIZED . $36NATURE
0E1 20 2 15e 1: 12 2 L000 241: 9000 LLD Lir
DETACH AND RETAIN THIS STATEMENT
THE ATTACHED CHECK IS IN PAYMENT OF ITEMS DESCRIBED BELOW. IF NOT CORRECT PLEASE NOTIFY US PROMPTLY. NO RECEIPT DESIRED.
DATE DESCRIPTION AMOUNT
esolution has reduced taxes
PARCEL 10222559 , TAX YEAR 2014
PHASE: 00033, RES NUM: 04795
02/20/2015 820215 SLIP 201500116 CHECK TOTAL: $424.96 ,
HARLAND CLARKE M20015 404991395 MARICOPA COUNTY TREASURER
CHARLES "HOS" HOSKINS, COUNTY TREASURER 820215
SERVICING BANK ACCOUNT