REDACTED - JERI M.-LEONEL E. ANDERSON #958122.PDF

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

L
M A R) C Oo PA C oO U NTY ; Phone: (602) 506-8511

TREASURER’S OFFICE

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

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

Cathy Sanchez (DZD

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

Re: Stale Dated Warrant

Name Warrant Amount | Dept/School
No

JERI M ANDERSON 958122 $638.77 | Treasurer

LEONEL E ANDERSON

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

This application is for: O Duplicate or Ki] 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.

J éri } At A ner son (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 5] a /a2 (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

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warrant/check be issued to him/her in the sum of ¢ 4 38 alate
Signed: os ve WY" y LOR DOV (4)
Print name: (required) J er; AM. Anderson

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

(3)

(5) Subscribed and sworn to before me this g day of Dec. 20AuU.

v .
Quadeye MMe teh __permmmonrraraa
ARY PUB! fa ZS Notary Public, py a ,

Maricopa County
Commission # 630245
My Commission Expires

My commission expires:

sy 3l, 2Oz> SF July 31, 2026
Warrant/Check Number ss
(if known) (6) As 6122
Original Date of Issue an
(if known) (7) 5/3 | }23

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

O For Services or Goods furnished

Aq 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 A.R.S. 11-632 & 11-644
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Maricopa County Treasurer's "T 141-59-324 9 12/11/2024 3:40:35 PM
FBR 141-59-324 9 - x
File Help |

Year | Description | Act Date | Tran Num | Amount | Images | PmtDate | Half Code | Act A

2024 = TAX PAYMENT 2024-09-18 0075-05119 $2,321.20 N 2024-09-17 F 7:3¢
TAX BILL 2024-08-24 Y 12:
TAX PAYMENT 2023-10-04 = 071-64752 $2,347.70 N 2023-09-29 -F 6:4:
TAX BILL -08-26 Y: 12:
REFUND \
RES REFUND LETTER 2023-05-30 N Bc
RES IMPOUND 2023-05-30 AS -03516 $638.77 N B4
TAX PAYMENT 2023-05-30 RS -03516 $2,297.28 N 2022-09-29 F B4
POST NEW TAX (RESOLUTION) 2023-05-30 AS -03516 $2,297.28 N B4y

< >

Parcel #: fi 41-59-324 Activity: REFUND Act Date05/31/23
Tax Year: [2022 Tran #:[- Eat Act Timefi2:00 AM

Activity Detail Address Detail |

| bie

| CP #: jo Check Date: 05731 723

| Buyer #: {0 Check #: [958722

Fund Pe SSCS Refund Amount: [$638.77

| Click icon for Disbursements Inquiry. -----> al

View

Image...

ricopa County Treasurer's Office Refund ID 2023009598 RESOLUTION 12/11/2024 3:41::

Refund ID 2023009598 RESOLUTION - Oo x
> Help
ry
efundAmount [863877 Requester; [RESOLUTIONS on 5/30/2023
efund Reason: [Resolution has reduced taxes Status: [DISBURSED on 5/30/2023
Slip ID: {202300248
Address| [JERI M ANDERSON Check Request: [RESO DESK
LEONEL E ANDERSON Reference t: [RES # 03516 |

npounds | Stub | Comments |

Impound #1 2 |
Source Fund | Linked | Amount | Tax Year | Status Parcel/Roll [141-53-324 Dest fund : [026
033 True $638.77 2022 READ CP tt: fo Reso #: [3516 |

CP buyer #:/0 Phase #: [80

Mortgage code:
£ > Transaction #: — |RS 03516
Impound Total: 1 Case #t: l.