REDACTED FOR AGENDA ATTACHMENT - JEFF AND HILARY SMEDSRUD.PDF
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v MARICOPA COUNTY TREASURER’S OFFICE Phoenix, Arizona 8500: Phone: (602) 506-851 rer.maricopa.go' John M. Allen, Treasurer 301 West Jefferson St., Rm. 100 3 1 Vv To: Clerk of the Board clerk.agenda@maricopa.gov Dorene.Stretar@Maricopa.Gov From: Treasurer's Office wy Katelyn Hale katelyn.hale@maricopa.gov 602-506-3357 Cathy Sanchez or cathy.sanchez@maricopa.gov 602-506-7881 Re: Stale Dated Warrant Name Warrant Amount | Dept/School No SMEDSRUD JEFFREY C/HILARY K 1226024 1400.94 | Treasurer MAR COPA Application for a Duplicate or Stale Dated COUNTY Warrant/Check Affidavit/Claim Form This application is for Duplicate or [X(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 3ru ea, Ct ilo, (1), being first sworn, upon oath deposes and says: Name/Claimant On or about V4 (2-4 (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 $__1, 4o¢ . *4 . (8) Signed:__\ = yu Suzie, [ (4) Print Name: (required). dsc % Note: Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issues. (5) Subscribed and sworn to before me this Z3 day of oy. bl 2025. NOTARY PUBLIC \ «rey Vaitncb TAA My co JEREMY E KIENITZ Notary Public Minnesota ission expires: My Commission Expi Jan 31, 2030 (seal) 7 Warrant/Check Number 1230024 Original Date of Issue (if known) (7) q | 4 ) 2 4 Reason for original issue of Warrant/Check (8): O) Payroll C For Services or Goods furnished Treasurer's refund/payment 0 Other: S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Current Claim Form\100518 Warrants Checks notice of claim.doc Revised 100518 a r 15 \y ARS. 11-632 & 11-644 ue ro) iA martcopa Maricopa County Treasurer's Office — John M. Allen Maricopa County COUNTY. . Treasurer Check Details for Check Number: 1226024 301 W Jefferson Street, . Suite 100 Payee: SMEDSRUD JEFFREY C/HILARY K Phoenix, AZ 85003- Issue Date: 9/4/2024 2199 Check Amount: $1,400.94 Reference Number Approved By Details Amount CC-01302924 PHASE #2016-9100; PARCEL #216-73-420 ; RES $1400.94 #30313 PHASE #2016-9100; PARCEL #216-73-420 ; RES #30313 Total $1400.94 Date: 11/13/2025 2:56 PM Page 1 of 1