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MARICOPA COUNTY DEPARTMENT OF TRANSPORTATION 2901 W. Durango Street e Phoenix, AZ 85009 Phone: (602) 506-4889 PATENT EASEMENT ABANDONMENT APPLICATION Note: Completed forms may be submitted to MCDOTPI. icopa.gov or mailed to the MCDOT office. Incomplete applications may result in delay of review. | Contact Information Applicant Name: RC Mu Rog aon PAB Number: _@ 2 © 4 Mailing Address: “2-6 0077 _A/ etd) AVE City: Pho enpr state: “72 zip: 65 O FF Phone (G02)- 877 - ZZ 60 Email: 7 0.7 0S AZ 2-060 © yohon, COM [ Parcel Detail Assessor's Parcel Number: 2/©_- /2_ - 007~E 1. Location of Request: (ex: 3200 W. Dove Valley Road, Phoenix) 26 ov Not AVE Pho end. AL 6S0¥¢ 2. Description of Request: (ex: Abandon Easement bordering the South side of parcel 123-45-067A) Abondonea tkasce ment bordening f he dort South 2s tect, lle st 9 feet, 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. 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. py) ‘ | 1 Lem Geox & 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 My Commission Expires: Jan 25, 202” Ie ae 5 j ———————ae 219 “Bl Maricopa County Commission # 621746 Notary Public Sint” My Comm. Expires Jan 25, 2026 ) - c s e =, CIM 022 Signature of Applicant Date Maricopa County Use Only Application Fee*: $1,600 Check #: TI38SG(749g Total Received P/SSD.CO Date: Ladlugsl 22022_ Rec'd By! Retenpt # JOHAL Cc *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. Payer Name: REMUS BOGDAH Maricopa County Department of Transportation 2901 W. Durango Street, Phoenix, AZ 85009 Receipt Receipt #: Payment Date: 26007 N 19TH AVE Receipt Type: PHOENIX , Arizona 85085 Reference #: Deseription Payment Type PATENT EASEMENT ABANDONMENT APPLICATION / REMUS Check BOGDAN 101121 8/23/2022 Patent Easements APN 210-12-007E / PAB 0204 Transaction # Amount, 7735617496 $1,350.00 Total: $1,350.00