REDACTED-FOR AGENDA ATTACHMENT-DIANNE AND SIMON REILLY LIVING TRUST-#1031618.PDF

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

MA RI COPA COUNTY agi rrsietnneat
TREASURER’S OFFICE

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

From: Treasurer's Office Vw
Maria Quitangon
maria.quitangon@maricopa.gov
602-506-1958

Cathy Sanchez ay ?

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

Re: Stale Dated Warrant

Name Warrant Amount | Dept/School
No

DIANNE AND SIMON REILLY 1031618 $141.41 | Treasurer

LIVING TRUST

MAR ICOPA Application for a Duplicate or Stale Dated

COUNTY arrant/Check Affidavit/Claim Form
This application is for- [| Duplicate or [AStale-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

. ‘ ‘ Vt nb eS CAR
D ANOS and i man. de) Ly aa e ), bebo frat dard, upon oath deposes and says:

| tHeck ss ope "\ Cele Reeavss: thE 120257

On or about va (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 $ IA. ie (3) (A414) Poe
Signed_2 OF wer UY (4) ®
Print Name: (required) DA ANNIE. KEL —. Yon es // ‘a

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 to before me this

NOTARY PUBLIC a ae Miguel Freytag

Netary Public
Maricopa County, Arizona
My Comm. Expires 04-22-28 \
Commission Na, ShR635
i & aay 35 i

My commission expires:
Of 2f20L9

| Warrant/Check Number
(€ know) (6) 103/e18

Original Date of Issue
(ifknown) (7) August 8 , 2ra4
Reason for original issue of Warrant/Check (8):
{] Payroll

a or Goods furnished
reasurer's refund/payment

9. Other: CQhasimnuar — DPyectmre _!'760b 789

SAPROCESSES Warrants - Duplicate or Stale\02 Forms\Current Claim Forn\100518 Warrants Checks notice of claim.doc Revised
100518

ARS, 11-682.811-644
VERIELED

gales

a

File Help
Year | Description | Act Date | Tran Num | Amount | Images | Pmt Date [ Half Code | Act
2019 RES REFUND CHECK LETTER 2024-08-19 N 8:4E
2019 RES IMPOUND 2024-08-19 AS -04056 $868.93 N 6:3
2019. TAX PAYMENT 2024-08-19 RS -04056 $601.78 N 2020-02-14 F 6:38
2019. TAX PAYMENT 2024-08-19 RS -04056 $1,285.98 N 2019-10-30 F 6:38 |
2019 =POSTNEW TAX (RESOLUTION) 2024-08-19 RS -04056 $1,887.76 N 6:3
2019 CANCEL TAX 2024-08-19 RS -4056 $2,571.96 N 6:38
2019 RESTORE TAX 2024-08-19 RS -04056 $1,285.98 N 1 6:38
2019. RESTORE TAX 2024-08-19 RS -04056 $1,285.98 N F 6:3
2016 REFUND 2024-08-08 z $141.41 N 12:
Parcel #: [176-06-789 Activity: REFUND Act Date08/08/24
Tax Year: [2016 Tran #: [7- fe] Act Time {12:00 AM
Activity Detail | Address Detail |
CP #: [0 Check Date: [08/08/24
Buyer #: [9 Check #: [1031618
Fund: [26 Refund Amount: $141.41
&. Refund ID 2024071160 RESOLUTION = a}
File Help
Sik
Refund Amount, [$141.41 Requester: [RESOLUTIONS on 8/6/2024
Refund Reason: [Resolution has reduced taxes Status: [DISBURSED on 8/6/2024
Slip: {202400711
Address: 'VING TRUST Check Request: JQASIMYAR GROUP
Reference #: |RES #04810
Impounds | Stub | Comments |
[ Impound #1
Source Fund | Linked | Amount | TaxYear_| Status Parcel/Roll:|176-06-783 Dest fund : 026
033 True $141.41 2016 READ] cpy: [0 Reso#: [4810
CP buyer # {a Phase #: {sooo
Mortgage code: [
Transaction #: [08402057
Impound Total : 1 Case #: J