REDACTED - FOR AGENDA ATTACHMENT - JOHN R. HINZ #1138159.PDF

L
MARICOPA COUNTY

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

Phone: (602) 506-8511

http://treasurer.maricopa.gov
TREASURER’S OFFICE
To: Clerk of the Board
clerk.agenda@maricopa.gov
Dorene.Stretar@Maricopa.Gov
From: Treasurer's Office
Katelyn Hale kt
katelyn.hale@maricopa.gov
602-506-3357
Cathy Sanchez C
cathy.sanchez@maricopa.gov
602-506-7881
Re: Stale Dated Warrant
Name Warrant Amount | Dept/School
No
HINZ JOHN R 1138159 $337.03 | Treasurer

MAR COPA Application for a Duplicate or Stale Dated

COUNTY Warrant/Check Affidavit/Claim Form
This application is for Duplicate or E|stale-pated (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
-< = “va 2 2 tb re (1), being first swron, upon oath deposes and says:

Name/Claimant

On or about __¥ [2.0 lo uf (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 $_ 44,77. OF _. (3)

Signed o 5 (4)
Print Name: (reqdired) Jatin KA? Hinz
Note: Please attach a copy of the warrant/check if available and/or any other evidence that a
warrant/check was originally issues.

Tt
(5) Subscribed and sworn to before me this 09 day of Soph nore
WW OdeVra
NOTARY PUBLIC’

WILLIAM J NELSON
Notary Public
Minnesota

My commission expires: RH) My Commission Expires

ola (20z¥ Jan 31, 2028

Warrant/Check Number — :
(if known) (6) +t il 4 Y1S9
Original Date of Issue
(if known) (7) 3/ gn j/ Quy
Reason for original issue of Warrant/Check (8):
O Payroll

O) For Services or Goods furnished

& Treasurer's refund/payment
CO) Other:

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

ARS. 11-6328 11-644 VeriReot vw 4123)

HB 217-30-366 2

File Help
Year | Description | Act Date | Tran Num | Amount | Images | Pmt Date | Halt Code |
2020 RES IMPOUND 2024-11-05 RS -29118 $533.59 N
2020 TAX PAYMENT 2024-11-05 RS -29118 $835.30 N 2021-04-22 F
2020 TAX PAYMENT 2024-11-05 RS -29118 $1,265.92 N 2020-10-26 F
2020 POST NEW TAX (RESOLUTION) 2024-11-05 RS -29118 $2,101.22 N
2020 CANCEL TAX 2024-11-05 RS -29118 $2,531.84 N
2020 RESTORE TAX 2024-11-05 AS -29118 $1,265.92 N 1
2020 RESTORE TAX 2024-11-05 AS -29118 $1,265.92 N F
2024 = TAXBILL 2024-08-24 Y
2019 REFUND 2024-08-20 $337.03 N
Parcel #: [217-30-365 Activity: [REFUND Act Date:08/20/24
Tex Year: [2019 Tran # [- Act Timei200AM
Activity Detail | Addiess Detail |
CP #: [0 Check Date: [08/20/24
Buyer: [9S Check #: [1738159
Fund [26° Refund Amount: [$337.03
& Refund ID 2024178139 RESOLUTION -
File Help
SR)
RefundAmount: |$337.03 Requester, [RESOLUTIONS on 8/19/2024
Refund Reason [Resolution has reduced taxes Status: [DISBURSED on 8/19/2024

Sip ID: [202400830

Address: [HINZ JOHN R

Check Request: |QASIMYAR GROUP

Reference #: [RES # 09544

Impounds | Stub | Comments |

Source Fund | Linked | Amount | Tax Year_| Status
033 True $337.03 2019 READ
Impound Total : 1

Impound #1
Parcel/Rol :|217-30-386 Dest fund : [026
cpe#: [0 Reso: [9544
CP buyer # :|0 Phase #: [5000
Mottgage code: [
Transactions: [08402080
Case #: [