REDACTED-FOR AGENDA ATTACHMENT-OWEN BRIGGS AND ANNE CHIPPS-#1221405.PDF
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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 Me Maria Quitangon maria.quitangon@maricopa.gov 602-506-1958 Cathy Sanchez C cathy.sanchez@maficopa.gov 602-506-7881 Re: Stale Dated Warrant Name Warrant Amount | Dept/School No OWEN BRIGGS 1221405 $234.04 | Treasurer ANNE CHIPPS MA R) COPA Application for a Duplicate or Stale Dated COUNTY Warrant/Check Affidavit/Claim Form This application is for L] Duplicate or 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 — Owenee ‘ees [awn Cpe Ss (1), being first sworn, upon oath deposes and says: Name/Claimant On or about®9/4/252¥ (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 yay the sum of $. 23%, . (3) Signed: Bp 2 PP (4) Print Name: (required) OWEN [SRIGes 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 metis LEO day of Sphember— 20.239 NOT UB CHRISTOPHER ROUNS Notary Public - Arizona Maricopa County Commission # 657852 My Comm. Expires Sep 21, 2027 sea My commission expires: G. 21-2027 Ww t sranvoheccnymber | 12aiuos Original Date of Issue (if known) (7) 5/4 [20 Y Reason for original issue of Warrant/Check (8): O1 Payroll O For Services or Goods furnished ~ y<8 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 VERE E? ARS. 11-632 & 11-644 ats Jes pe Ez 200-29-867 3 File Help Year_| Description [ActDate [| TranNum | Amount | Images | PmtDate | Half Code | Act 2017 RES REFUND CHECK LETTER 2024-09-04 N 8:5 2017 ~=RES IMPOUND 2024-09-04 RS -45665 $237.34 N 64 2017 = TAX PAYMENT 2024-09-04 RS -45665 $849.51 N 2018-04-16 FF 6:4 2017 = TAX PAYMENT 2024-09-04 RS -45665 $1,018.23 N 2017-10-30 -F 6:4 2017 =POSTNEWTAX(RESOLUTION) 2024-09-04 RS -45665 $1,867.74 N 64 2017 = CANCEL TAX 2024-09-04 RS -45665 $2,036.46 N 6:4 2017. RESTORE TAX 2024-09-04 RS -45665 $1,018.23 N 1 64 2017 RESTORE TAX 2024-09-04 RS -45665 $1018.23 ON F 6:4 v REFUND 04 4.04 N 12 Parcel #: |200-29-867 Activity: [REFUND Act Date:09/04/24 Tax Year: 2016 Tran #:[- | Act Timei2:00 4M Activity Detail | Address Detai | CP #: [0 Check Date: [09/04/24 Buyer #: [0 Check #: [1221405 Fund: [26 Refund Amount: $234.04 BS. Refund ID 2024261455 RESOLUTION = a} File Help 4i& Refund Amount [$234.04 Requester, [RESOLUTIONS on 9/3/2024 Refund Reason: [Resolution has reduced taxes Status: [DISBURSED on 9/3/2024 Slip ID: 202400941 Address: NNE Impounds | Stub | Comments | Check Request: [GASIMYAR GROUP Reference #: [RES # 26195 Source Fund_| Linked | Amount | Tax Year | Status 033 True $234.04 2016 Impound Total: 1 Impound #1 Patcel/Roll :|200-29-867 Dest fund : |026 READ! cee: [0 Resott: [26195 CP buyer #:|0 Phase #: [3100 Mottgagecode: [ Transaction # : fossooo0nti“(‘é éS™S Case #: |