REDACTED - FOR AGENDA ATTACHMENT - YAHONG TU.PDF

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

L Phoenix, Arizona 85003
M A RI C re) PA C Oo U N TY __ Phone: (602) 506-8511

TREASURER’S OFFICE

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

From: Treasurer’s Office Wy
Maria Quitangon

maria.quitangon@maricopa.gov
602-506-1958

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

Re: Stale Dated Warrant

Name Warrant Amount Dept/School
No
YAHONG TU 957604 $1,029.80 | Treasurer

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

This application is for: O Duplicate or 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.
N ahr Tu (1), being first sworn, upon oath deposes and says:
Name/Claimant f, . —
On or about Git] ri ad (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

warrant/check be issued to him/her in the sum of $/) 029. So (3)
Signed: Va AS we (4)
Print name: (required) YA HO. NG TK

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

(5) Subscribed and_sworn to before me this | 2 day of Ocdn ber 20. ZY ;

MARISA GARDNER

Notary Public - Arizona

My commission expires: eee wasbinoebae rtd

Commission # 615182

bce | Ope (seal)
Warrant/Check Number alt 4
(if known) (6) V5 760 Ye
Original Date of Issue —
(if known) (7) 5 J! fad /23
Reason for original issue of Warrant/Check (8):
0) Payroll
0 For Services or Goods furnished
bf 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 ARS, 11-632 & 11-644
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Maricopa County Treasurer's Office 310-11-825 6 10/21/2024 1:58:50 PM
FB 310-11-825 6 = x
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Year | Description | Act Date | Tran Num | Amount | Images | Pmt Date | Half Code | Act A
2015 TAX PAYMENT 2024-08-02 AS -18111 $1,039.23 N 2015-10-28 -F 1 a
2015 POSTNEWTAX(RESOLUTION) 2024-08-02 RS -18111 $1,872.90 N 31%
2015 CANCEL TAX 2024-08-02. AS -18111 $2,078.46 N Sy
2015 RESTORE TAX 2024-08-02 RS -18111 $1,039.23 N 1 31°
2015 RESTORE TAX 2024-08-02. AS -18111 $1,039.23 N F Lak
2023. TAX PAYMENT 2024-04-03 053-97789 $1,015.99 N 2024-03-31 -F 7:3
2023. TAX PAYMENT 2023-10-23 0052-18404 $1,015.99 ¥ 2023-10-20 1 6:3¢
2023 TAX BILL Y. 12:

Click icon for Disbursements Inquiry.

2022 . REFUND i 12:09
< >
Parcel #: [310-11-825 Activity: [REFUND Act Date:05/17/23
Tax Year: [2022 Tran #:[- fe Act Time {i200 AM
Activity Detail | Address Detail |
CP #: jo Check Date: jo511 7/23
Buyer #: io Check #: | 957604
Fund: [26 Refund Amount: | $1,029.80

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Refund ID 2023008528 RESOLUTION

&. Refund ID 2023008528 RESOLUTION
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Sj

RefundAmount: —[$1.029.80

Requester: |RESOLUTIONS on 5/15/2023

| Refund Reason: [Resolution has reduced taxes

Status: JDISBURSED on 5/15/2023

Slip 1D: [202300230

Address: T

Impounds | stub | Comments |

Check Request |RESO DESK

Reference #: [RES #03630

ee]
ay

Amount | Tax Year | Statu
$1,029.80 2022 REAL

Source Fund | Linked |
033 Tue

Paicel/Rll [31011825 Dest fund : 026
CP#: fo Reso #: 3630
CP buyer # [0 Phase #: |7e

Mottgagecode: [
Transaction #: [RS 03630

Impound Total: 1

Case #: |

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10/21/2024 1:59:14