REDACTED - FOR AGENDA ATTACHMENT - MICHAEL R. SIMMONS #1082992.PDF

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

L
M A R) C oO PA C Oo U N TY . Phone: (602) 506-8511

rer.mari -gov
TREASURER’S OFFICE

To: Clerk of the Board
clerk.agenda@maricopa.gov
Dorene.Stretar@Maricopa.Gov

From: Treasurer’s Office
Katelyn Hale ki
katelyn.hale@maricopa.gov

602-506-3357

Cathy Sanchez LQ
cathy.sanchez@marti¢opa.gov
602-506-7881

Re: Stale Dated Warrant

Name Warrant Amount | Dept/School
No
SIMMONS MICHAEL R 1082992 $194.66 | Treasurer

L
MA R) COPA Application for a Duplicate or Stale Dated

COUNTY Warrant/Check Affidavit/Claim Form
This application is for Duplicate or x 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
MM iC hae MY AS (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about g (4/ a 4 (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 Ve licant requests that a replacement warrant/check
be issues to him/her in the sum of $. | 266 (3)

Signed: MAL Ogi ee (4)
Print Name: (required) Michee|(  R- SIiMMonSs

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

Subscribed and gworn to before me this _|t day of Sete Moce 20_25
eA) CHI

NOTARW PUBLIC OU one

My commission expires:
{[O'O7l= 2OD%

KEYAJA SMALLEY
Notary Public - Arizona
Maricopa County
i Commission # 636261 s pal)
My Commission Expires October 07, 202

Werreny Check Number za) $2 172

Original Date of Issue g / | 4/. 2 4

Reason for original issue of Warrant/Check (8):
O Payroll
O For Services or Goods furnished

JK 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. 11-6328 11-644 Ven co 23

HB 308-13-331 5

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Year_| Description [ActDate | TranNum | Amount| Images _| PmtDate | Half Code
2016 RES REFUND CHECK LETTER 2024-09-03 N
2016 RES IMPOUND 2024-09-03 RS 37792 $257.19 N
2016 TAX PAYMENT 2024-0903 RS 37792 $220612 N 2017-07-31 F
2016 POST NEW TAX (RESOLUTION) 2024-0903 RS 37792 $2,20612 N
2016 CANCEL TAX 2024-0903 RS 37792 $2385.40 N
2016 RESTORE TAX 2024-09-03 RS -37792 $2,305.40 N F
2024 INFO STATEMENT 2024-08-25 N
2024 TAXBILL 2024-08-24 Y
2017 REFUND 2024-08-14 $194.66 N
Parcel #: [308-13-331 Activity: [REFUND Act Date {08714724
Tex Year: [2017 Tran#[- Jind | Act Timefi2:00 AM
Activiy Detail | Address Detail |
( Check Date: [08714724
Buyer #: [9 Check #: [f082382
Fund [26 SOS RefundAmount [— $194.66
BS Refund ID 2024122530 RESOLUTION - o

File Help

SiR

Impounds | Stub | Comments |

Refund Reason:

RefundAmount [$194.66

Requester, [RESOLUTIONS on 8/8/2024

[Resolution has reduced taxes

Status: [DISBURSED on 8/8/2024

Slip 1D: [202400765

Address: [SIMMONS MICHAEL R

Check Request |QASIMYAR GROUP

Reference # |RES # 16983

Source Fund | Linked |

Amount | Tax Year | Status

033 True

$194.66 2017

READ)

Impound Total: 1

Impound #1
Parcel/Roll:[30813-331 Dest fund:[026
ces. [0 — Resow: [16983
CPbyert:|0 Phase: [7000
Mottgagecode: [

Transaction #: fos4o20s8 Cts
Case #: [©