Extracted text (via ocr_local)
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pap 22
=) / MARICOPA COUNTY DEPARTMENT OF TRANSPORTATION
i) bas] i 2901 W. Durango Street e Phoenix, AZ 85009
aie. Phone: (602) 506-4889
PUN
Note: Completed forms may be submitted to MCDOTPlanning@Maricopa.gov diled, to the MCDOT office.
Incomplete applications may result in delay of review.
Contact Information
Applicant Name: {OI ¢ Mollenbowue PAB Number: if Ms
Mailing Address: 4 IK \Al. Dargon ¢ Ro ”
city: Peli state: _[\Z zip: 95095
Phone (((/3 ) - V5 - 2315 Email: omy @ bethomaz., co”
Parcel Detail
Assessor's Parcel Number: Alb. - 04. : 4 Ht
1. Location of Request: (ex: 3200 W. Dove Valley Road, Phoenix)
Mla W. Parsons Rd, Phochex
2. Description of Request: (ex: Abandon Easement bordering the South side of parcel 123-45-067A)
Abandon Easebtent bolder) the East side uf parcel ad -WA-DE
3. Applicant is REQUIRED to be the current owner of the described property. A copy of your property deed
must be attached to the application.
PATENT EASEMENT ABANDONMENT soa
I certify, under penalty of perjury, that no loss of currently existing legal and physical access to any property
will occur if the County grants the patent easement abandonment requested in this application.
4. If you have a mortgage, deed of trust, upon your property you are REQUIRED to provide a letter from the
lender approving your request to abandon a patent easement. Applications submitted without lender approval
will not be processed. If you don’t have a mortgage or deed of trust on the subject property, you will need
to sign, before a notary, the affidavit below attesting to that status.
1 1 hows Uo lle ole attest that I own the subject property and that it is not encumbered by
mortgage or deed of trust.
Subscribed and sworn to before me this Fem 1
qh hau \ f - 2 Nanary up. State of Arizona
@ S aricopa County
, day of Y p20 W
Commission # 668171
\o——__ Or My a ee al
ee wa Notary Public __ _ _
oO? Signature
Signature of Applicant Date
Maricopa County Use aut
Application Fee*: $1,600
) ow
Check #: 3. FS Total Received:_ “7S 0” Date: NJ 0), Toe Rec'd By:
*Application Fee will be $1,350 ($1,600 less $250) if Initial Determination letter is provided; demonstrating an initial review
of the parcel was conducted by the County within the last six months. The application fee is NOT refundable. Make checks
payable to: MCDOT 2901 West Durango Street Phoenix, AZ 85009.
Maricopa County Department of Transportation
2901 W. Durango Sireet, Phoenix, AZ 85009
Receipt
Payer Name: Receipt #: 101142
BETHOM CONTRACTING LLC Payment Date: 9/19/2022
1515 W DEER VALLEY RD C-108 Receipt Type: Patent Easements
PHOENIX , Arizona 85027 Reference #: PAB 0212 - APN 210-09-014H
PAB 0212 - APN 210-09-014H Check 2695, $1,350.00
Total: $1,350.00