090716 STALE DATED WARRANTS 2 - FINANCE.PDF

MARICOPA COUNTY
Department of Finance
301 West Jefferson, Ste 960
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM CO 0
Date: August 11,2016
To: Clerk of the Board
From: Beth Brown r .ri
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: First Arizona Title Agency

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: D 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
Pane 2 of this form.
FIRST ARIZONA TITLE AGENCY ( 1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 15-May-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 issu d to him/her in the sum of $ 1,066.62 .(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.
ubscribed and sworn to before me this day of 20
TARY PUBLIC
OFFICIAL SEAL
MAcoinMission expires: SANDRA McCULLOUGH :
Notify Pubic - Slate of Arizona !
MARICOPA COUNTY i (seal)
My Corn. Expires Jtiy 6, 2019 j
Warrant/Chedk Number 824165
(if known) (6)
Original Date of Issue 15-May-2015
(if known) (7)
Reason for original issue of Warrant/Check (8):
El Payroll
111 For Services or Goods furnished
El Treasurer's refund/payment Overpayment of Property Taxes
Li Other:

First Arizona Title Agency
16155 North 83rd Avenue, Suite 105
FIRST ARIZONA Peoria, AZ 85382
TITLE AGENCY Phn - (623)385-1000
Fax - (623)385-1036
August 8, 2016
Maricopa County Department of Finance
Attn: Beth Brown
301 West Jefferson, Ste 960
Phoenix, AZ 85003
Via regular courier
Re: Affidavit/Claim Form: Parcel#400-52-115 Check#824165 for $1,066.62
Dear Beth:
This is to advise that Vicia Nunley, in her capacity as Escrow Officer, is authorized to sign the Affidavit/Claim form
on behalf of First Arizona Title Agency.
Thank you for your assistance in this matter.
You can reach me direct at 623-385-1000 if you need to contact me.
Sincerely,
FIRST ARIZONA TITLE AGENCY
Marisa Carrillo
Escrow Manager

JPMorgan Chase Bank, N.A.
MARICOPA COUNTY TREASURER PHOENIX, AZ 824165 2
CHARLES "HOS" HOSKINS, COUNTY TREASURER ACH R/T 122100024 824165 ;
SERVICING BANK ACCOUNT 91-2/1221
057Y5/2015
PAY
1066 Dollars and 62 Cents $1,066.62
TO THE ORDER OF
FIRST ARIZONA TITLE AGENCY CHECK VOID AFTER 365 DAYS
MARICOPA COUNTY TREASURER
16155 N 83RD AVE STE 105 CHARLES "HOS" HOSKINS, COUNTY TREASURER
PEORIA AZ 85382
MEMO AUTHORIZED SIGNATURE
08 24 L650 L 2 2 L000 2 1-o: 9000 L 110 Lo
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
Retund Reason: Overpayment at property taxes
Parcel 400-52-115 Tax Year 2014
ESCROW # 25-152001
ORIGINAL CK # 2519024
CK DATED 04-16-2015
05/15/2015 824165 SLIP 201500320 CHECK TOTAL: $1,066.62
HARLAND CLARKE M20845 40498895 MARICOPA COUNTY TREASURER
CHARLES "HOS" HOSKINS, COUNTY TREASURER 824165
SERVICING BANK ACCOUNT