REDACTED-FOR AGENDA ATTACHMENT-DALE T BUSENBARK INVESTMENTS LLC-#1230135.PDF

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

v
M A R) C Oo PA C Oo U N TY Pho (602) 506-8511

rer.maricopa.gov
TREASURER’S OFFICE

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

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

Cathy Sanchez (CS
cathy.sanchez@maricdépa.gov
602-506-7881

Re: Stale Dated Warrant

Name Warrant Amount | Dept/School
No
DALE T BUSENBARK INVESTMENTS | 1230135 $574.37 | Treasurer
LLC

Application for a Duplicate or Stale-Dated Warrant/ Check

Affidavit/Claim Form

This application is for: oO Duplicate or XI'stale-Dated (definitions are on page 2)

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

D (ea /, (<f 7 ‘Bs sen lowe /< (1), being first sworn, upon oath deposes and says:
Name/Claimant

On or about O TQ “ 26 aF (date)(2) a warrant/check was issued to the
above named person/entity in the amount as 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 issued to him/her in the sum of $ = TH, be Z (3)
Signed: “Dake vd Gurren bk rhe (4)
Print name: (required) 7) c/eTo Bus enbark Ln vestme ut Ss

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

(5) Subscribed and sworn to before me this LY day of sty’ 20ZS.

yA VO |\hy

NOTARY PUBLIC
. ; GENERAL NOTARY-State of Nebraska
My commission expires: - Pia i
A tt Yconl)
Warrant/Check Number :
(if known) (6) / o. XO l a 5
Original Date of Issue
(if known) (7) GIA RS
Reason for original issue of Warrant/Check (8):
O Payroll
O For Services or Goods furnished
WY Treasurer's refund/payment
OO Other:
S;\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Current Claim Form\100518 Warrants Checks notice of claim.doc
Revised 100518 A.RS, 11-632 & 11-644
VERE?

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File Help

Year | Description | Act Date | Tran Num | Amount | Images | Pmt Date | Half Code |
2017 RES REFUND CHECK LETTER 2024-09-04 N
2017 ~=RES IMPOUND 2024-09-04 RS -§2989 $569.93 N
2017 = TAX PAYMENT 2024-09-04 AS -§2989 $536.54 N 2018-04-16 F
2017 = TAX PAYMENT 2024-09-04 RS -§2989 $941.70 N 2017-10-30 F
2017 + =POST NEW TAX (RESOLUTION) 2024-09-04 RS -52989 $1,478.24 N
2017 = CANCEL TAX 2024-09-04 RS -52989 $1,883.40 N
2017 RESTORE TAX 2024-09-04 RS -§2989 $941.70 N 1
2017 RESTORE TAX 2024-09-04 RS -52989 $941.70 N F
2016 REFUND 2024-09-04 E $574.37 N
Parcel #: |232-43-950 Activity: [REFUND Act Date:09/04/24
Tax Year: [2016 Tran #: [- | Act Timesi2:00.4M

Activity Detail | Address Detai |

cP# [> Check Date: [09704724
Byer: [0 Check #: [1230135
Fund 26 °° | RefundAmount ["————SS«'5}74.37
© Refund ID 2024270185 RESOLUTION - o
| File Help
Ey
| Refund Amount [5743700 Requester: [RESOLUTIONS on 9/3/2024
Refund Reason: [Resolution has teduced taxes Status: [DISBURSED on 9/3/2024
Slip 1D: [202400949
Addess: [DALE TBNSENBARK INVESTMENTS LLC Check Request: |GASIMYAR GROUP

Reference #: |RES # 33956

Impounds | stub | Comments |

Impound #1
Source Fund | Linked | Amount | Tax Year | Status Parcel/Rol [23243950 Dest fund : [026
033 True 957437 2016  READ| cpy. fo Reso: [33856
CP buyer #t:[0 Phase #: [9100

Mortgage code :
Transaction #: — |08400001

Impound Total : 1 Case #:

ENTITY INFORMATION
Search Date and Time: 9/17/2025 10:40:25 AM

Entity Details ~
Entity Name:
DALE T BUSENBARK INVESTMENTS LLC
Entity ID:
L18286446
Entity Type:
Domestic LLC
Entity Status:
Inactive
Formation Date:
2/28/2013
Reason for Status:
Approval Date:
3/6/2013
Status Date:
10/22/2019
Original Incorporation Date:
2/28/2013
Life Period:
Perpetual
Business Type:
Last Annual Report Filed:
Domicile State:
Arizona
Annual Report Due Date:
Years Due:
Original Publish Date:
4/4/2013

Name:
DALE T BUSENBARK

Appointed Status:

Active

Attention:

Address:

5/15/2013

Agent Last Updated:

E-mail:
Attention:
Mailing Address:

County:

Principal Information

Date of Taking Last
Office Updated

Title Name Attention Address

Manager = 2/28/2013 3/6/2013
Ser BUSENBARK /28/ /8/

Page 1 of 1, records 1 to 1 of 1

Address (@}

Attention:

County: Maricopa
Last Updated: 3/5/2013

Entity Principal Office Address

Attention:
Address:

oy Outlook

Qasimyar Inquiry Form

Date Fri 8/15/2025 5:52 PM

ee

First Name: Dale
Last Name: Busenbark

|

Parcel: 23243950
Tax Year: 2015, 2016

Message: Didn't receive check dated 08-06-2024 for 334.56. Tax year 2015

Didn't receive check dated 09-04-2024 for 574.37. Tax year 2016

Both of these checks were sent to address | left 3 years ago.

| did receive check dated 02-04-2025 today for 373.19 it was forwarded to new address. Tax year 2017

Please send new check/checks to my current address:

Thank you,

Dale T Busenbark Investments LLC