REDACTED- FOR AGENDA ATTACHMENT - JERRY AND LYNN CODY #1051290.PDF

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

v
M A R) C Oo PA C oO U N T Y __ Phone: (602) potent

Vv
TREASURER’S OFFICE

To: Clerk of the Board

clerk.agenda@maricopa.gov
Dorene.Stretar@Maricopa.Gov

From: Treasurer's Office
Katelyn Hale a)

katelyn.hale@maricopa.gov
602-506-3357

Cathy Sanchez (2

cathy.sanchez@maricopa.gov
602-506-7881

Re: Stale Dated Warrant

Name Warrant Amount | Dept/School
No
CODY JERRY/ LYNN 1051290 $380.31 | Treasurer

L
MA R) COPA Application fora Duplicate or Stale Dated

COUNTY

Warrant/Check Affidavit/Claim Form

This application is for L} Duplicate or Stale-Dated (definitions are on page 2)

STATE OF ARIZONA
COUNTY OF MARICOPA

Note: Numbers on this form correspond to the numbers
on the Instruction sheet which is page 2 of this form

es

a Cody Jevr wv) / } yar (1), being first swron, upon oath deposes and says:
me/Claimant

On or about August 12,202 (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 subDSequently 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 inthe sumof$_ #360. 3] — (3)

Signed» £ (4)
Print Naffe: (required) L

Note: Please attach a copy of the warrant/check if available and/or any other evidence that a
warrant/check was originally issues.

o TH P
(5) ie a to before me this % “day of YE ?/< “7 S©f 99 2S.
se Nee

NOTARY PUBLIC

My commission expires:

GF. 297 -27107F

JAN PAULE
NOTARY PUBLIC
STATE OF COLORADO
NOTARY ID# 20234037034
MY COMMISSION EXPIRES SEPT. 29, 2027

Warrant/Check Number
(if known) (6) [O51390
Original Date of Issue
(if known) (7) August ID... A054

Reason for original issue of Warrant/Check (8):

O) Payroll

C1 For Services or Goods furnished

4 Treasurer's refund/payment

O Other:

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

100518

ARS. 11-632 & 11-644

Voaried Ky 4/23

fi: 304-83-734 3 = x
File Help
Yea | Description [ActDate | TranNum | Amount | Images | PmtDate | HalfCode | Act
2017 ‘TAX PAYMENT 2024-09-17 RS -42164 $647.13 N 2018-0430 F oT
2017 TAX PAYMENT 2024-09-17 RS -42164 $1,099.73 N 2017-10-26 F 31
2017 ~=POSTNEW TAX(RESOLUTION) 2024-09-17 RS -42164 $1,746.86 N 31°
2017 CANCEL TAX 2024-09-17 RS -42164 $2,193.45 N s1)]
2017 RESTORE TAX 2024.09.17 RS -42164 $1,099.73 N 1 31
2017 RESTORE TAX 2024-09-17 RS -42164 $1,099.73 N F 31
2024 INFO STATEMENT 2024-08-25 N 12
2024 «= TAXBILL 2024-08-24 Y 12
2016 REFUND 2024-08-12 $380.31 N 12
Parcel #: 304-83-734 Activity: [REFUND Act Date08/12724
Tax Year: 2016 Tran #[- | Act Time {i2:00 AM
Activity Detail | Address Detail |
cP # fo Check Date: fos7i 2/24
Buyer [OSS Check #: ff051280
Fund [SOS RefundAmount [~———«$380.31
& Refund ID 2024090705 RESOLUTION - i) x

File Help

ety

RefundAmount {$380.31

Requester: [RESOLUTIONS on 8/6/2024

Refund Reason: _ [Resolution has reduced taxes

Status: |DISBURSED on 8/6/2024

Slip 1D: [202400731

Address: IPNNV.IFRRV/AYNN

Check Request: |GASIMYAR GROUP

Reference #: [RES 8 19232

Impounds | Stub | Comments |

Source Fund | Linked |

Amount | Tax Year | Status

033 True

$380.31 2016

READ

Impound Total: 1

Impound #1
Pacel/Rall :|304-83-734 Dest fund :|025
CP H: jo Reso#: |19232
CP buyer #t [0 Phase #: [8000
Mortgage code: [—
Transaction #: [08402057
Case #: [