REDACTED-FOR AGENDA ATTACHMENT-DALE T BUSENBARK INVESTMENTS LLC-#1014171.PDF

l
MARICOPA COUNTY

TREASURER’S OFFICE

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

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

To: — Clerk of the Board
clerk.agenda@maricopa.gov
Dorene.Stretar@Maricopa.Gov
From: Treasurer’s Office
Maria Quitangon all
maria.quitangon@maricopa.gov
602-506-1958
Cathy Sanchez Sa)
cathy.sanchez@maricopa.gov
602-506-7881
Re: Stale Dated Warrant
Name Warrant Amount | Dept/School
No
DALE T BUSENBARK INVESTMENTS | 1014171 $334.56 | Treasurer

LLC

MAR‘{COPA Application for a Duplicate or Stale Dated

COUNTY Warrant/Check Affidavit/Claim Form
This application is for ea Duplicate or Xfstate-pated (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
= p is je ‘a B. usenu Ly ark (1), being first swron, upon oath deposes and says:
Name/Claimant

On or about OF-O - ) 6 2% (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 subsequenily 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 $ 33 YW. bat 4 _- (3)

Signed Dake Er Pisin harhe (4)
Print Name: (required) (ole 7 Dissen baut- Duves(me at s
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 Le day of A va ust 20 8.

NOTARY PUBLIC
Koller. (oho : GENERAL NOTARY-State of Nebrasa

My eS. 24°

Ww heck bi
ieee [2147

Original Date of Issue

(fknow) (7) Of-o6- 200%

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

4 Treasurer's refund/payment

-. Other: i DB 7

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

a) a3]

3-950 2 =

File Help
Year | Description | Act Date | Tran Num | Amount | Images [ Pmt Date | Half Code [
2016 TAX PAYMENT 2024-09-03 RS -33956 $518.28 N 2017-08-01 F
2016 = TAX PAYMENT 2024-09-03 AS -33956 $909.64 N 2016-09-24 F
2016 POST NEW TAX (RESOLUTION) 2024-09-03 RS -33956 $1,427.92 N
2016 CANCEL TAX 2024-09-03 AS -33956 $1,819.28 N
2016 RESTORE TAX 2024-09-03 RS -33956 $909.64 N 1
2016 RESTORE TAX 2024-09-03 RS -33956 $909.64 N F
2024 INFO STATEMENT 2024-08-25 N
2024 = TAXBILL 2024-08-24 Y
2015 REFUND 2024-08-06 - $334.56 N
Parcel #: [232-43-950 Activity: [REFUND Act Date {08/06/24
Tax Year: [2015 Tran #: [- Bl Act Time‘12:00 4M
Activity Detail | Address Detail |
CP #: [0 Check Date: [08/06/24
Buyer #: [0 Check #: [1014171
Fund: [26 Refund Amount: $334.56
&. Refund ID 2024053586 RESOLUTION - o
File Help
82)
Refund Amount: — |$334.56 Requester, [RESOLUTIONS on 8/2/2024
Refund Reason: [Resolution has reduced taxes Status: [DISBURSED on 8/2/2024
Slip ID: [202400683
Address: TS LLC Check Request, [QASIMYAR GROUP
Reference #: |RES # 13600

Impounds | Stub | Comments |

Impound #1
Source Fund | Linked | Amount | Tax Year_| Status Parcel/Roll:|232-43-950 Dest fund : [026
033 True $334.56 2015 READ CPt: Jo Reso: [13600
CP buyer #:|0 Phase #: [9000

Mortgage code : |
Transaction #: [08402056
Impound Total : 1 Case tt: |

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:
Agent Last Updated:

5/15/2013
E-mail:
Attention:

Mailing Address:

County:

Principal Information

Date of Taking Last
Office Updated

toe | 2/28/2013 3/6/2013
: BUSENBARK /28/ /6/

Title Name Attention Address

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:

= A

a Outlook

Qasimyar Inquiry Form

From
Date Fri 8/15/2025 5:52 PM

ao

First Name: Dale
Last Name: Busenbark

Email:

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