072215 STALE DATED WARRANTS.PDF

CLERK
MARICOPA COUNTY !)A !OAF.R OF SUPE -R
Department of Finance HARICOPA
301 West Jefferson, Ste 960 2015 JUN 30 AN 8: 41,
Phoenix, Arizona 85003 inclivf'duat
INTEROFFICE MEMORANDUM
Date: June 30, 2015
To: Clerk of the Board
From: Joyce Maurmann
Department of Finance
Subject: Notice of Claim — Replacement of Stale dated Warrant
Please find attached 1 Notice of Claim for a stale dated warrant to be included on the
next available Board Agenda.
• The attached item have been researched to ensure the warrant in
question have not been cashed or previously re-issued.
• The original warrant is stale dated.
Please call me at 506-1343 if you have any questions. Please return the approved
Notice of Claim to my attention in the Department of Finance, Suite 960.
Thank you.
Re: Leonard Miceli

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: 0 Duplicate •or ig 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
oacie 2 of this forrn.
Leonard Miceli (1), being first sworn, upon oath deposes and says:
NamelUairnant
On or about 12-Jul-2013 (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 e, issued to him/her in the sum of $7,808.84 .(3)
---
Signed: .-----,..---2,( ,I2. ( -,:-C"- ..‘ t 4 (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 2'5- day of Sk.k rrr 20
NOTARY PUBLIC
KIM KNOX
My commission expires: Notary MARICOPA Public - State COUNTY ciAitorta
`g - 1- My Commission August 1,2017 Expkes (seal)
Warrant/Check Number 793109
(if known) (6)
Original Date of Issue 12-Jul-2013
(if known) (7)
Reason for original issue of Warrant/Check (8):
E Payroll
El For Services or Goods furnished
Treasurer's refund/payment reduced taxes
El Other:

793109 I
JPMorgan Chase Bank, N.A.
MARICOPA COUNTY TREASURER PHOENIX, A2
CHARLES "HOS" HOSKINS, COUNTY TREASURER ACM R/T 122100024 793109 t
SERVICING BANK ACCOUNT 91-2/1221
_42 1.7
07/11/2013
7808 Dollars and 84 Cents
PAY
$7,808.84
luded.
TO THE ORDER OF Inc
CHECK VOID AFTER 365 DAYS
MARICOPA COUNTY TREASURER Features
MICELI LEONARD CHARLES "HOS" HOSKINS, COUNTY TREASURER
ST2012-000652 rity
Secu
MEMO
0793 L090 1: L2203002111: 9000 0-10
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
Refund Reason: Resolution has reduced taxes
Parcel 135-32-020D Tax Year 2012 Reso Phase 00111 Reso # 15649
REFUND IN ACCORDANCE WITH JUDGMENT
IN TAX CASE 5T2012-000652
n7/12/2011 791109 RLTP 20110018 CHECK TOTAL - $7,808 84
HARLAND CLARKE M2094S 131139054 MARICOPA COUNTY TREASURER
CHARLES "HOS" HOSKINS, COUNTY TREASURER 793109
SERVICING BANK ACCOUNT