REDACTED-FOR AGENDA ATTACHMENT-QUIKTRIP CORPORATION-#981308.PDF

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

ly Phoenix, Arizona 85003
MAR) COPA COUNTY cin eee
TREASURER’S OFFICE

See ae ae EES ae mz

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

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

Cathy Sanchez C5
cathy.sanchez@maricopa.gov
602-506-7881

Re: Stale Dated Warrant

Name Warrant Amount Dept/School
No
QUIKTRIP CORPORATION 981308 $9,048.25 | Treasurer

v
MAR)COPA
COUNTY

Application for a Duplicate or Stale Dated
Warrant/Check Affidavit/Claim Form

This application is for L_] Duplicate or Stale-Dated (definitions are on page 2)

STATE OF ARIZONA
COUNTY OF MARICOPA

QuikTrip Corporation

Note: Numbers on this form correspond to the numbers
on the Instruction sheet which is page 2 of this form

(1), being first swron, upon oath deposes and says:

Name/Claimant

On or about 3/13/2024 (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 $9,048.25 . (3)

Signed:__-AQ 4 _—— (4)

Print Name: trequired) QuikTrip Corporation (By: Deborah Rowden, Property Tax and Audit Manager)

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 me this gg day of Aepttindeer 20. 25-

NOTARY, PUBLIC- ~~ D
My commission expires:

9 3[.24

Warrant/Check Number
(if known) (6)

Original Date of Issue
(if known) (7)

(seal)

981308
3/13/2024

Reason for original issue of Warrant/Check (8):
O Payroll
O For Services or Goods furnished

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 Vert aa

4/13 jus re

ADC 11.429 2.11-4AA

[BB 143-48-074E 7 - x
File Help
Year_| Description | ActDate | TranNum_| Amount | Images | PmtDate | Half Code |
2022. RESTORE TAX 2024-05-08 AS -86843 $17,769.29 N F
2021 RES IMPOUND 2024-05-08 AS -86842 $26,328.69 N
2021 TAX PAYMENT 2024-05-08 RS -86842 $15,517.58 N 2021-11-01 F |
2021 POST NEW TAX (RESOLUTION) 2024-05-08 AS -86842 $15,517.58 N
2021 CANCEL TAX 2024-05-08 AS -86842 $38,276.34 N
2021 RESTORE TAX 2024-05-08 RS -86842 $19,138.17 N 1
2021 RESTORE TAX 2024-05-08 AS -86842 $19,138.17 N F
2023 TAX PAYMENT 2024-04-25 MO -A172 $12,111.91 _N 2024-04-16 =F
2 REFUND $9 h

Parcel #: |143-48-074E Activity: [REFUND
Tax Year: [2020 Tran#[- [zal
Activity Detail | Address Detail |
cP# fo —t—~<“CtiC‘~™S Check Date: [03/13/24
Buyer #: [0 Check #: [981308
Fund: [26 Refund Amount: $9,048.25

{ BY Refund ID 2024016962 RESOLUTION

Act Date:03/13/24
Act Time‘12:00 4M

ar

: File Help
Fry
RefundAmount: [$3048.25 Requester: [RESOLUTIONS on 3/12/2024
Refund Reason: [Resolution has reduced taxes Status: |DISBURSED on 3/12/2024
Slip ID: [202400268
Address: [QUIKTRIP CORPORATION Check Request, [RESO DESK

Impounds | Stub | Comments |

Reference #: [PHASE # 00370

Impound #1

Source Fund _| Linked |

Amount | Tax Year | Statu

Parcel/Roll :|143-48-074E

033 True $3,048.25 2020

Dest fund : [026

Impound Total : 1

REAL CP #: Jo Reso#: [81252
CP buyer # Jo Phase #: [370
Mortgage code: [4172
Transaction #: |S 81252
Case #:

QuikTrip Corporation

e = 4705 S 129th E Ave
QuikTrip Tulsa, OK 74134
° Jimmy Brown Jr.
- Tax

|, Jimmy Brown Jr., in my official capacity as Director of Tax, Assistant Secretary of QUIKTRIP CORPORATION

OFFICER'S STATEMENT OF AUTHORITY

(the “Company”) being first duly sworn, do hereby certify that Deborah Rowden is a duly appointed and acting Property
Tax and Audit Manager of the Company and as such is authorized to execute and deliver all documents on behalf of the
‘Company, its subsidiaries -and affiliated entities, pertaining to the recovery or credit of--undistributed; unclaimed,

uncashed, or undelivered funds owned by the Company, its subsidiaries and affiliated entities.

nd .
IN WITNESS WHEREOF, | have hereunto set my hand this co) day of Be picin ber- 20225,

jifeCfor of Tax, Assistant Secretary
a, OK 74134

ACKNOWLEDGEMENT OF NOTARY PUBLIC

State of _© Halaoma,

City/County of Tulsa

~ ‘Acknowledged before me on this Pe) aah day of September 20 o7 by
Jimmy Brown Jr., to me well known or proved to me on the basis of satisfactory evidence to be the individual described
herein and who executed the foregoing instrument and acknowledged the execution thereof to be his free act and deed.

)
) ss.
)

Ry
Witness my hand and official seal. _ Sau

— -
} A) f
Notary Signature: ( loa).

My Commission Expires: __ 7/4/24

7

“SO, UPS
“toa an