REDACTED - FOR AGENDA ATTACHMENT - BLOOMFIELD FAMILY TRUST #967638.PDF

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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 MW
Maria Quitangon
maria.quitangon@maricopa.gov
602-506-1958

Cathy Sanchez

cathy.sanchez@maricopa.gov
602-506-7881

Re: Stale Dated Warrant

Name Warrant
No

Amount | Dept/School

BLOOMFIELD FAMILY TRUST 967638

$312.41 | Treasurer

Application for a Duplicate or Stale-Dated Warrant/Check

Affidavit/Claim Form Coun’,
This application is for: fe] Duplicate or re vate (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.

ts < 2 Vici! (1), being first sworn, upon oath deposes and says:
Name/Claimant C2 &€> 7

On or about Leet 2o ZS (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/hes in the sum of $_ 9/2 + £/ (3)
Signed: > Zz ss (4)
Print name: (required) Biiiee/ Plan titio Twin Llvotghib <p
TR kLKAaL

Note. Please attach a copy of the warrant/check if available and/or ay “bther
evidence that a warrant/check was originally issued.

(5) Subscribed and sworn to before me this_S-+_day of Felowans 2025.

NOTARY PUBVIC

S$ Greening
Notary Public - ARIZONA
PINAL COUNTY
Commission No. 6534S8al)
My Commission Expires 07/31/2027

My commission expires:

O71 31-2027

Warrant/Check Number
(if known) (6) Pb ZEISS

Original Date of Issue
a oe ean {ferriave, OF (2024

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

0 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 ARS, 11-632 & 11-644

Ve MIFIED
afyhs pH

Maricopa County Treasurer's Office 141-80-102 1 2/4/2025 12:38:23 PM

‘EB 141-80-102 1 - a x
| File Help
Year | Description | Act Date | Tran Num | Amount | Images | Pmt Date | Half Code | Act
| | 2023. RES REFUND LETTER 2024-04-02 N 7:0;
| | 2023. RES IMPOUND 2024-04-02 RS -39631 $310.15 N 7:00
|) 2023 TAX PAYMENT 2024-04-02 RS -39631 $642.23 N 2024-01-21 F 70°
| | 2023 POST NEW TAX (RESOLUTION) © 2024-04-02 AS -39631 $629.64 N 7:00 |
| 2023) CANCEL TAX 2024-04-02 AS -39631 $925.96 N fal
2023. =RESTORE TAX 2024-04-02 AS -39631 $944.48 N F 7:0
2023 RESOLUTION REPRINT 2024-04-02 iy 12:
N 2024-01-21 F 63

2023 TAX PAYMENT 2024-01-24 071-69014 $944.48
ag REFUND 2024-01-09 + $312

Parcel #: {141-80-102 Activity: JREFUND Act Date:(01/09/24
Tax Year: J2022 Tran #:[- Hel Act TimefiZ00 AM

| Activity Detail | Address Detail |

Cs Check Date: |OT/09/2F
Buyer#: 0 Check #: [967638
Funt [E—————_ReARLHR] ———ETT coy

Click icon for Disbursements Inquiry. ---->

View Image...

Maricopa County Treasurer's Office Refund ID 2024000570 RESOLUTION 2/4/2025
12:37:38 PM

| (S. Refund ID 2024000570 RESOLUTION erie) Eli.
ee _ ;
ty
Refund Amount: [8312.41 Requester: [RESOLUTIONS on 1/8/2024 |
Refund Reason: [Resolution has reduced taxes Status: |DISBURSED on 1/8/2024 | |
Sip ID: 202400013 | |
Address: Check Request: |NOPC GROUP
| Reference #: |RES #39307
|

Impounds | Stub | Comments |

Im; #1

Source Fund | Linked | Amount | Tax Year_| Status -Parcel/Rot:{141-80102 Dest fund : [026
033 True $312.41 2022 READ} cpx: [0  — Reso: [39007
CP buyer #0 Phase #: fis?

Mortgage code: [
Transaction # : JRS 39307
Impound Total: 1 Case #: j

Unofficial

RECORDING REQUESTED BY i
AND WHEN RECORDED MAIL TO: 20°Docul Y ent
BRIAN G. BLOOMFIELD
2301 NORTH NICKLAUS DRIVE LF
MESA, AZ 85215 msi
COURTESY-NO TITLE LIABILITY
No Title Liability aa

‘SPACE ABOVE THIS LINE FOR RECORDER'S USE

Exempt Per ARS 11-1134 B8
QUIT CLAIM DEED

For consideration of Ten Dollars, and other valuable considerations, I/we,

Brian G, Bloomfield, a widower,
do/does hereby convey to

Brian Gordon Bloomfield, Trustee of The Bloomfield Family Trust, dated December 14", 2016
all right, title or interest in the following real property situated in Maricopa County, State of Arizona:

See Attached Exhibit A

Dated: May 25, 2022

G sass

Brian G. Bloomfie)d
Date: p

saat Aber eno: On this X71 day of_ 11 , 2022, before me

personally appeared Brian G. Blootfield, whose identity was proven

C f “e to me on the basis of satisfactory evidence to be the person who he or
aay 9 * - she claims to be, and acknowledged that he or she signed the

above/attached document.
(Affix notury soa! here) Cee ad
‘iar Public ]
am > My commission expii 06.02.23

Page 1 of 2

20220461406

EXHIBIT A
LEGAL DESCRIPTION

Lot 914, of APACHE WELLS MOBILE PARK UNIT FOUR, according to the Plat of record in the office of the County
Recorder of Maricopa County, Arizona, recorded in Book 116 of Maps, Page 48.

Page 2 of 2

20220461406

TRUST CERTIFICATION

Brian Gordon Bloomfield, Trustee, hereby declares, ratifies and affirms, under penalty of
perjury, the following statements to be true and correct:

1.

The The Bloomfield Family Trust (Name of Trust) is currently in existence and was executed on
12/14/2016.

2. The settlor(s) of the Trust are: Brian Gordon Bloomfield.

ite

The currently acting Trustee(s) of the Trust and address(es) is (are):
Brian Gordon Bloomfield
2301 N Nicklaus Drive Mesa, AZ 85215
The power of the Trustee(s) includes:
(a) The power to sell, convey and exchange: J Yes [] No
(b) The power to borrow money and encumber the trust property with a Deed of Trust or
Mortgage: IX] Yes [J No
The Trust is IX] Revocable [7] Irrevocable
If Revocable, the following party(ies) is (are) identified as having the power to revoke the trust:
(a) [Brian Gordon Bloomfield]
The Trust [] Does [XJ Does Not have multiple Trustees.
(a) If the Trust has multiple Trustees, the signatures of the Trustees are required to exercise the
powers of the Trust: (mark one of the following)
DUALL DANY conan

Pursuant to A.R.S. 33-404, the Beneficiaries (and their addresses) for the above referenced
Trust are as follows:

Brian Gordon Bloomfield, 2301 N Nicklaus Drive Mesa, AZ 85215

The undersigned Trustee(s) declare(s) that the Trust has not been revoked, modified or amended in any
manner which would cause the representations contained herein to be incorrect.

Dated: May 25, 2022

TRUSTEE:

ra

x

aD
-

Briar G. Bloomfield

4

Page 1 of |

Affidavit of Cenification of Trust

20220461406

COURTESY RECORDING INSTRUCTIONS
(No_ATSA Escrow File)

| ** This page must be attached to the document(s) being sent for recording. **

The undersigned hereby requests that American Title Service Agency, LLC. record at its convenience as a courtesy, the following
documents:

Quit Claim Deed and Certification of Trust
The undersigned acknowledges and understands that:

This instrument, given with no expressed consideration, monetary or otherwise, is executed voluntarily and not as the result of
duress or threats of any kind, and is a bona fide and not given to hinder, delay or defraud the rights of creditors or contravene
the bankruptcy laws of the United States.

a, This document(s) has not been prepared by American Title Service Agency, LLC., in connection with any escrow which it is ,
administering or otherwise, and American Title Service Agency, LLC. is not acting as and is not assuming any of the duties or
obligations of an escrow agent in connection with the recordation of the above-referenced document(s). In addition, the
parties agree that American Title Service Agency, LLC. is not responsible or liable for any compensation due to or ftom the
parties hereunder, given or expected, as a result of this transaction.

b. American Title Service Agency, LLC. is acting at the request of the undersigned, without compensation of any nature, solely
to act in the capacity of a messenger to deliver said document(s) to the office of the County Recorder for recording;
c. American Title Service Agency, LLC. has not performed any title search or examination, nor has it verified the correctness of
any legal description pertinent to said document(s); and
d. American Title Service Agency, LLC. has not examined the contents, signature(s) or notarization of said document(s) for
accuracy, legal compliance or correctness of purpose.
Further, the undersigned acknowledges bargained for consideration between the parties to these instructions and hereby
specifically releases, holds harmless and agrees to indemnify, merican Title Service Agency, LLC. from and against any and all
liability and responsibility and expense of whatever nature involved in connection with any aspect of the preparation, content, legal
efficacy, excoution or notarization of said document(s), whether fumished to the undersigned as a blank form or not, or in
connection with its timely recording, and regardless of whether it is ever recorded or not, for any reason, including the loss or
misplacing of said document(s) by an employee or agent of American Title Service Agency, LLC., County Recorder or anyone
else.
Recording fees in the amount of $35.00 are attached.
* All checks MUST BE payable to American Title Service Agency, LLC.

Date: May. 29] 2022

Signature(6) of Requesting Party: Address of Requesting Party:
er

al

J
<Brian G. Bloomfield SS

Document forwarded to the recording desk by:
Marie Lightner

Courtesy Recording Instructions (No ATSA File)