REDACTED-FOR AGENDA ATTACHMENT-LISA ANN MUSSELMAN AND GARRY EDWARD MUSSLEMAN-#1156617.PDF

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

v
M A R) Cc Oo PA Cc oO U N T Y Phone: (602) 506-8511

rer.maricopa.gov
TREASURER’S OFFICE

ES

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

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

Cathy Sanchez le
cathy.sanchez@maricopa.gov
602-506-7881

Re: Stale Dated Warrant

Name Warrant Amount | Dept/School
No

LISA ANN MUSSELMAN 1156617 $274.19 | Treasurer

GARRY EDWARD MUSSLEMAN

MA AY COPA Application for a Duplicate or Stale Dated
COUNTY rrant/Check Affidavit/Claim Form

This application is for | Duplicate or ‘Eilstale- Dated (definitions are on page 2)

STATE OF ARIZONA Note: Numbers on this form correspond to the numbers |
COUNTY OF MA ICOPA on the Instruction sheet which is page 2 of this form

Sacry Ed Wuss hn

Lisa Bonin Musse\m an (1), being first swron, upon oath deposes and says:
Name/Claimant

On or about B-2l- 2024 (date} (2) a wairant/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 $ Q774, ! q 2172 (3)

‘Signed Sevca re WheraorD wh» GZ

Print Name: (required) Cisg Ann Wlusselfraw/ Gor ry Edun Wusselma n,

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

(©) Sapa anfnerp toe mets xiii day of 2 PIE
ee ;

NOTARY PUBLIC

John Joseph Kemp
Notary Public
Navajo, Arizona
My Comm, Expires 05/01/2027

My commission expires: Commission No, 649716

0670) (MA? ieee

‘Warrant/CheckNumber |,
(if known) (6) } | — brlo | wi

Original Date of Issue

(if known) (7) S-a!-Q0a4
Reason for original issue of Warrant/Check (8):
( Payroll

( For Services or Goods furnished

OXf Treasurer's refund/payment _

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

100518 Verrier
ARS 11-689 811-644 lis ley

Pe

La
HB 141-67-635 3

File Help
Year | Description [ Act Date | Tran Num | Amount | Images | Pmt Date | Half Code | Act
2021 POSTNEWTAX(RESOLUTION) 2024-11-12 RS -20276 $1814.18 N 55°
2021 CANCEL TAX 2024-11-12 RS -20276 $2,510.88 N 55
2021 RESTORE TAX 2024-11-12 RS -20276 $1,255.44 N 1 55°
2021 RESTORE TAX 2024-11-12 RAS -20276 $1,255.44 N F 55°
2024 =TAX PAYMENT 2024-11-01 MO -F608 $907.59 N 2024-10-31 1 8:3e
2024 INFO STATEMENT 2024-08-25 N 12:
2024 =TAXBILL 2024-08-24 Y 12:
2020 REFUND 2024-08-21 $227.57 N 12:
2020 REFUND 2024-08-21 $274.19 N 12:6
Parcel #: |141-67-635 Activity: REFUND Act Date08/21/24
Tax Year: [2020 Tran #[ - Act Time/i2:00 AM
Activity Detail | Address Detail |
cP# {fo —t—~<“iC~™S Check Date: [08/21/24
Buyer#: [0 Check #: [1156617
Fund: [26 Refund Amount: $274.19

& Refund ID 2024196454 RESOLUTION

File Help

S\Q)

RefundAmount: [$274.19

Refund Reason:

Requester: |RESOLUTIONS on 8/20/2024

[Resolution has reduced taxes

Status: |DISBURSED on 8/20/2024

Slip ID; [202400851

Address:

Impounds | Stub | Comments |

RY EDWARD

Source Fund | Linked |

Amount | Tax Year [ Status

033

True $274.19 2020

READ!

Impound Total :

1

Check Request: |QASIMYAR GROUP

Reference #: [RES #01243

Impound #1
Parcel/Roll i 41-67-635 Dest fund: jo26
cp#: [0 Reso#: [1243
CP buyer #:|0 Phase #: [4000

Mottgagecode: [
Transaction #:  |08402061

Case #: [ti‘“‘CS:s~S™S

Ga Outlook

Qasimyar Inquiry Form

From
Date Wed 8/27/2025 3:10 PM

First Name: Lisa
Last Name: Musselman

Phone: as
Email
Parcel: 14167635

Tax Year: 2020, 2021, 2022, 2023

Message: Yesterday we received one check that was for year 2022 in the amount of $344.99, it was
originally mailed to the wrong address and was forwarded to us. There are 5 more checks that have been
issued and all have gone to the wrong address. | was able to update our mailing address with your office