REDACTED-FOR AGENDA ATTACHMENT-JOE GILLESPIE-#1037463.PDF

v
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 a
Maria Quitangon
maria.quitangon@maricopa.gov
602-506-1958
Cathy Sanchez C2
cathy.sanchez@mMiari€opa.gov
602-506-7881
Re: Stale Dated Warrant
Name Warrant Amount | Dept/School
No
JOE GILLESPIE 1037463 $192.65 | Treasurer

F .
MA R) COPA Application for a Duplicate or Stale Dated

COUNTY Warrant/Check Affidavit/Claim Form
This application is for Duplicate or Ly 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
Jone? US SF iWespiS (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about b/s, Ze2t (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 $_\"A4- GS . (3)
Signed: Soul Soa (4)

Print Name: (reqeftred) Thec a (7 Wes eit

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

y,
(5) Subscribed and sworn to before me this SZ. day of LA pe 202 =

NOTARY PUBLIC, Zy, the KM ELn2

ANGELA L ADKINS —
My commission expires: “ones
AOL 211 2029 ak

Warrant/Check Numb a,
aan emown) 6) S03 7463

Original Date of Issue yp O. 2 02 oy
_ — ¢ c

(if known) (7)

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

] For Services or Goods furnished

WY 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 Venwied
G/t 4 aw

ADS 11.429 2.11-4AA

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Bl 212-39-263 2 - x
File Help
Year [ Description | Act Date [ Tran Num | Amount | Images | Pmt Date [ Half Code | Act
2017 = TAX PAYMENT 2024-09-17 AS -32894 $1,322.13 N 2018-04-16 FF 7:31
2017 = TAX PAYMENT 2024-09-17 RS -32894 $1,926.57 N 2017-10-30 -F 7:31
2017, POSTNEWTAX(RESOLUTION) 2024-09-17 RS -32894 $3,248.70 N 7:31
2017 = CANCEL TAX 2024-09-17 RS -32894 $3,853.14 N 7:31 |
2017 =RESTORE TAX 2024-09-17 AS -32894 $1,926.57 N 1 7:31
2017 ~=RESTORE TAX 2024-09-17 RS -32894 $1,926.57 N F 7:31
2024 = INFO STATEMENT 2024-08-25 N 12:
2024 = TAXBILL 2024-08-24 Y 12:(
2016 REFUND 2024-08-08 $192.65 N 12:
Parcel #: |212-39-263 Activity: [REFUND Act Date/08/03/24
Tax Year: [2016 Tran #:[- Jiad| Act Time 2:00 4M
Activity Detail | Address Detail |
CP #: jo Check Date: [08/08/24
Byer#: [0 Check #: [1037463
Fund: [26 Refund Amount: [ $192.65

pan an
BS Refund ID 2024077004 RESOLUTION

File Help

CJIey

Refund Reason:

Refund Amount: {$192.65

Requester, [RESOLUTIONS on 8/6/2024

[Resolution has reduced taxes

Status: |DISBURSED on 8/6/2024

Slip 1D: 202400717

Check Request. [QASIMYAR GROUP

Reference #: [RES # 09163

Impounds | Stub | Comments |

Source Fund | Linked |

Amount | Tax Year | Status

033 True

$192.65 2016

READ

Impound Total : 1

Impound #1
Parcel/Roll :|212-39-263 Dest fund: |026
cp#: [0 Resott: [3163
CP buyer #:|0 Phase #: [8000

Mottgagecode: [
Transaction #: — |08402057
Case #: [t~‘“‘CSCSCSCS