REDACTED - FOR AGENDA ATTACHMENT - BEJAMIN FUNKE #1026133.PDF

v
MARICOPA COUNTY

TREASURER’S OFFICE

John M. Allen, Treasurer
301 West Jefferson St., Rm. 100
Phoenix, Arizona 85003

Phone: (602) 506-8511
http://treasurer.maricopa.gov

To: Clerk of the Board
clerk.agenda@maricopa.gov
Dorene.Stretar@Maricopa.Gov
From: Treasurer's Office
Katelyn Hale Ky
katelyn.hale@maricopa.gov
602-506-3357
Cathy Sanchez As,
cathy.sanchez@maricopa.gov
602-506-7881
Re: Stale Dated Warrant
Name Warrant Amount | Dept/School
No
FUNKE BENJAMIN 1026133 $220.39 | Treasurer

MA AY COPA Application for a Duplicate or Stale Dated

COUNTY Warrant/Check Affidavit/Claim Form
This application is for Duplicate or &] Stale-Dated (definitions are on page 2) |
STATE OF ARIZONA Note: Numbers on this form correspond to the numbers
COUNTY OF MARICOPA on the Instruction sheet which is page 2 of this form

-—Denisrica i (1), being first swron, upon oath deposes and says:

Name/Claimant *

On or about August 32024 (date) (2) a warrant/check was issued to the above named
person/entity in'the amount 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 issues to him/her in the sum of $_22© . 39 eas)

Signed Fp 3 apt pinfy (4)

Print Name: (required) Peniarun Funke
Note: Please attach a copy of the warrant/check if available and/or any other evidence that a
warrant/check was originally issues.

(5) Subscribed and sworn sob rn to before spots this_ day of orem bor

NOTARY PUBLIC ay
Selena Iniguez Roman

Notary Public
Maricopa County, Arizona

My in expires:

Warrant/Check Number
(if known) (6) + 102.6133
Original Date of Issue te
(if known) (7) Avge t % ) 2014
Reason for original issue of Warrant/Check (8):
O Payroll
1 For Services or Goods furnished + ~ aaa 4
. The ck wag Mal on ovtdeto Ai
Treasurer's refund/payment Qasinyar Inquicy addivse Wh cick, is uh, “a was_pot osaalat nalad
on yeur OF Tssyance.

O Other:

New mailing addnes on File’. 4001 E Kein Dr, Varedise Valley Ke

S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Current Claim Form\100518 Warrants Checks notice of claim.doc Revised $5253
100518

ARS. 11-632 & 11-644
Venied Kt 4/23/25

‘ 133-07-102 7

File Help
Yea_| Description [ActDate | TranNum | Amount| Images _| PmtDate | Half Code_| Ac
2017 TAX PAYMENT 2024-03-17 RS -25269 $398.15 N 2018-04-15 F 54
2017 TAX PAYMENT 2024-0317 AS -25269 $1.15257N 2017-10-30 F 5:4
2017 POSTNEW TAX (RESOLUTION) 2024.09.17 RS -25269 $2,050.72 N 5:4
2017 CANCEL TAX 2024-09-17 RS -25269 $2305.14 N 5:4
2017 RESTORE TAX 2024-03-17 RS -25263 $1.15257 N 1 5:4
2017 RESTORE TAX 2024-0917 RS -25269 $1,152.57 N F 54
2024 INFO STATEMENT 2024-08-25 N 12
2024 = TAX BILL 2024-08-24 Y 12:
2016 REFUND 2024-08-08 $220.39 N 12
Parcel #: [133.07-102 Activity: REFUND Act Date 08/08/24
Tax Year: [2016 Tran# |. Act Time {i200 AM
Activity Detail | Addess Detail |
CP #: fo Check Date: [09/08/24
Buyer #: fo Check #: [1026133
Fund: 26S Refund Amount: [4220.33
SS. Refund ID 2024065675 RESOLUTION - oOo x
File Help
&|Q)
Refund Amount [$220.39 Requester; [RESOLUTIONS on 8/6/2024
Refund Reason: [Resolution has reduced taxes Status: [DISBURSED on 8/6/2024
Siip 1D: [202400705
Address: [FUNKE BENJAMIN Check Request: [QASIMYAR GROUP
Reference #: [RES # 00756
Impounds | Stub | Comments |
Impound #1
Souce Fund | Linked | Amount] Tax Year [Statue] Pace :!13307-102 Dest fund: 026
033 True $22039 2016 READ CPH: fo Reso: [756
CP buyer # :|0 Phase #: {e000
Mortgage code: [
Transaction #: [08402057
Impound Total : 1 Case #: |