REDACTED-FOR AGENDA ATTACHMENT-HELENA E HAMANN-#1159873.PDF

v
MARICOPA COUNTY

TREASURER’S OFFICE

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

Phone: (602) 506-8511
http://treasurer.maricopa.gov

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

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

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

Re: Stale Dated Warrant

Name Warrant Amount | Dept/School
No
HELENA E HAMANN 1159873 $678.28 | Treasurer

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

This application is for a Duplicate or XI 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

a O&M Aro Helene e (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about __ &-2\-2020\ (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 $_G ‘18.28 . (3)

Signed: £ Winer (4)

Print Name: (required) We. eng EL ere wes

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

oh uy Owed
NOTARY PUBLIC

(5) epson? ha nd sworn to before me this [pt day of poten bog 20k 5.
Vv

DEBBY RANIERI
Notary Public - Arizona

Maricopa County
. ¥ Commission # 655603
My a 108 expires: SWE" My Comm. Expires Sep 19, 2027

(seal)

Quo |" 2027]

Warrant/Check Number
(if known) (6) \ \ 5 QO S73

Original Date of Issue

(if known) (7) ¥-2\-Zody

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

CJ For Services or Goods furnished

‘Zl 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 A hr

a)whs
ARS. 11-632 & 11-644 / —

BS Refund ID 2024199711 RESOLUTION
File Help

i
RefundAmount: [$678.28

Requester: [RESOLUTIONS on 8/20/2024

Refund Reason: [Resolution has reduced taxes

Status: [DISBURSED on 8/20/2024

Slip ID: {202400854

Impounds | Stub | Comments |

Amount | Tax Year_| Status
$678.28 2020 READ)

Source Fund | Linked |
033 True

Impound Total : 1

Check Request: [QASIMYAR GROUP

Reference #: |RES # 03586

Impound #1
Parcel/Roll :|176-04-605 Dest fund : |026
CPH: jo Reso#: [3596
CP buyer # :|0 Phase #: [4000
Mottgagecode: [
Transaction # fosso2061——“(i‘Ct;é*#
Case #: [...

BB 176-04-605 8 -
File Help
Year | Description | Act Date | Tran Num | Amount | Images | Pmt Date | Half Code | Act
2021 TAX PAYMENT 2024-11-12 RS -22346 $1,608.37 N 2021-10-22 F 6:0¢
2021 =POSTNEWTAX(RESOLUTION) 2024-11-12 RS -22346 $2,269.20 N 6:0¢ |
2021 CANCEL TAX 2024-11-12 RS -22346 $3,216.74 N 6:0¢
2021 RESTORE TAX 2024-11-12 RS -22346 $1,608.37 N 1 6:0¢
2021 RESTORE TAX 2024-11-12 RS -22346 $1,608.37 N F 6:0¢
2024 = TAX PAYMENT 2024-11-01 MO -F608 $1,154.03 N 2024-10-31 1 8:2"
2024 = INFO STATEMENT 2024-08-25 N 12:
2024 = TAX BILL 2024-08-24 Y 12:(
2020 REFUND 2024-08-21 $678.28 N 12:
Parcel #: |176-04-605 Activity: REFUND Act Date|08/21/24
Tax Year: [2020 Tran #:[- Bl Act Time{12:00 AM
Activity Detail | Address Detail |
CP #: fo Check Date: [09/21/24
Buyer #: [0 Check #: [1159873
Fund 26 ° Refund Amount: $678.28

oF Outlook

Qasimyar Inquiry Form

Date Fri 9/12/2025 6:32 PM

First Name:Helena»

Last —
|

Phone:

Email]

Parcel: 17604605
Tax Year: 2020

Message: | see that a check was issued 8/21/24 | would like to inquiry the status of this check | have not
received it if mailed. Thank you for any help you can give me.