REDACTED-FOR AGENDA ATTACHMENT-THOMAS JOSEPH TRZASKA-#963492.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.maricopa.gov

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 C4

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

Re: Stale Dated Warrant

Name Warrant Amount | Dept/School
No
THOMAS JOSEPH TRZASKA 963492 15.76 | Treasurer

U
MA R) COPA Application for a Duplicate or Stale Dated

COUNTY Warrant/Check Affidavit/Claim Form
This application is for | Duplicate or [4 Stale-Dated (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
“Them AS [RZzASKA (1), being first swron, upon oath deposes and says:

Name/Claimant

On or about OCT O03 2023 (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 $ [$226 . (3)

Signed: Thou“ / (im (4)

Print Name: (required) THOMAS TRZASEA

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

(5) Subscri and sworn-to before me this ZB day of J bh 20 25°
NO PUBLIC davier Palma

gain, JAVIER PALMA
oo 5 Notary Pubtic - State of Arizona
My commission expires: sy MARICOPA COUNTY
y ommit 64!
WA aeetH 4 , 2027 gaits’ Expres March 4.2027 [asal)

Warrant/Check Number

(if known) (6) 963 vi es

Original Date of Issue

(if known) (7) OCT Os joe 023
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 VERICIED
ARS. 11-632 & 11-644 7/ea/es

pe

Hl 510-10-940 5

File Help
Year [ Description | Act Date [ Tran Num | Amount | Images | Pmt Date | Half Code | Act Time
2024 9=TAX PREPAYMENT 2024-08-26 086-19579 $34.98 N 2024-08-26 10:35:00 Aly
2024 ~~ BILL PRINT 2024-08-24 Y 12:00:00 Atv
2022 REFUND 2023-10-03 : $15.76 N 12:00:00 At
2023. TAX PREPAYMENT 2023-09-22  050-66535 $34.98 Y 2023-09-21 6:47:00 PM
2022 REDEMPTION PAYMENT 2023-09-18 0771-16624 $20.76 N 2023-09-13 6:32:00 PM
2023. TAX PAYMENT 2023-09-18  071-16624 $9.02 N 2023-09-13 1 6:32:00 PM
2023) TAX BILL 2023-08-26 Y 12:00:00 Ab
2021 REFUND 2023-07-21 : $33.52 N 12:00:00 Ab
2022. BTX_IMPOUND 2023-07-20 011-07418 $0.52 N 9:22:00 AM
Parcel #: |510-10-940 Activity: [REFUND Act Date10/03/23
Tax Year: [2022 Tran #:["- Jie] Act Time {12:00 4M
Activity Detail | Address Detail
CP #: [22001008 Check Date: [10/03/23
Buyer #: [6975 Check #: [963492
Fund: [50 Refund Amount: $15.76
B Refund ID 2023016603 CP_BUYER 0

File

2a)

Help

RefundAmount [$15.76

Refund Reason:

-_ a

\cP Redemption refund

Impounds | Stub | Comments |

Source Fund _| Linked |

Amount | Tax Year | Status

050 True $15.76 2022

READ‘

Requester:
Status:

Slip ID

Check Request:

Reference #:

F JECHECKWEB on 9/18/2023

. [DISBURSED on 10/3/2023

, }202300450

» [MAIL

. [CP 22001008

Impound #1

Parcel/Roll :|510-10-340 Dest fund : |050
CP#: 22001008 Reso#: |0
CP buyer # :|6975 Phase #: |0

Mortgage code :
07116624

Transaction # :