REDACTED - FOR AGENDA ATTACHMENT - MARK SCHAAF #958360.PDF

John M. Allen, Treasurer
301 West Jefferson St., Rm. 100
Phoenix, Arizona 85003

l
MAR) COPA COUNTY Par: (602) 806-1102

TREASURER’S OFFICE http://treasurer.maricopa.gov

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

From: Treasurer’s Office ye
Maria Quitangon
maria.quitangon@maricopa.gov
602-506-1958

Cathy Sanchez a>

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

Re: Stale Dated Warrant

Name Warrant Amount | Dept/School
No

Mark Schaaf 958360 $155.85 | Treasurer

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

This application is for: oO Duplicate or [ state-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.

IwRee ScrtAAE (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about MAY 1, , 20S (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 $. \ S De 8 ss. (3)
Signed: LU. Sy Ms elon (4)
Print name: (required) ew, Wack Schaar

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 day of 20
NOTARY PUBLIC
See Attached
Leet pues California All Purpose
My commission expires: ‘Acknowledgement
(seal)
Warrant/Check Number
(if known) (6) G S8 2 60
Original Date of Issue ‘
(if known) (7) WAX 3\ 2603
Reason for original issue of Warrant/Check (8):
0 Payroll
O For Services or Goods furnished
DY Treasurer's refund/payment
O Other:
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Current Claim Form\100518 Warrants Checks notice of claim.doc
Reviced 1NN51R ARS 11-827 & 11-Aa4a
Ve Ririe?
6/13/24

pe.

CALIFORNIA ACKNOWLEDGMENT CIVIL CODE § 1189

SEERA

Anotary public or other officer completing this certificate verifies only the identity of the individual who signed the document
to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.

State of mes ; 8 \
County of VW FORTIN WS

on__U- “J- 9034 a uleoel. Ne At Publi ¢

Date Here Insert Name and Title of the Officer

personally appeared Waele S (s Haak

Name(s) of Signer(s)

who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed
to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their
authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity
upon behalf of which the person(s) acted, executed the instrument.

| certify under PENALTY OF PERJURY under the
KERI WENSEL laws of the State of California that the foregoing

Notary Public - California paragraph is true and gorrect.
Riverside County z
Commission = 2341885 WITNESS my hand arid official seal.

Li)
c._(a

{
Y Signature of Notary Public

Place Notary Seal and/or Stamp Above

OPTIONAL

Completing this information can deter altération of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document Chich : ~—
Title or Type of Document: ; r aD 4 Wr ~ wWemert
Document Date: G7: D0 a Number of Pages:

Signer(s) Other Than Named Above:

Capacity(ies) Claii by S' r(s)
Signer’s Name: _/ Signer’s Name:
O Corporate Officer ‘e(s): O Corporate Officer — Title(s):

O Partner - © Limited O General O Partner -~sLLimited O General

1 Individual 0 Attorney in Fact Individual O Attorney in Fact

O Trustee O Guardian or Conservator Trustee Guardian or Conservator
O Other: O Other:

Signer is Representing: == Ss Signer is Representing:

M1304-09 (11/20)

Maricopa County Treasurer's Office

503-59-206B 5

6/13/2024 9:33:22 AM

REFUND
RES REFUND LETTER
RES IMPOUND

2020
2022
2022

<B

——
| Parcel #: /503-59-2068
Tax Year: [2020

$153.25

>

FE 503-59-206B 5 - x
File Help

Year | Description | Act Date ‘| Tran Num | Amount | Images | Pmt Date | Half Code a a

2023. TAX PAYMENT 2023-12-20 0052-93968 $757.14 2023-12-19 F

2023. +RESTORE TAX 2023-11-29 011-03597 $757.14 N F

2023. TAX PAYMENT 2023-11-27 = 0771-38481 $757.14 N 2023-11-20 F

2023. -TAXBILL 2023-08-26 Y

2022 REFUND 2023-05-31 : $158.12 N

2021 REFUND 2023-05-31 N

3-0 N
2023-05-30 AS -03553 $158.12 N
Activity: IREFUND Act Date:05/31/23
Tran#: | - a Act Time {i200 AM

Activity Detail | Address Detail |

CP #:
Buyer #:
Fund:

bt Check Date: [05/31/23
bh ~ CS Check #: [958360
fe © Refund Amount: $155.85

Click icon for Disbursements Inquiry. ----->

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Maricopa County Treasurer's Office Refund ID 2023009333 RESOLUTION 6/13/2024 9:33:00
AM

8. Refund ID 2023009333 RESOLUTION - a xX
File Help
ry
|Retund Amount: [$155.05 Requester [RESOLUTIONS on 5/30/2023
] Refund Reason: [Resolution has reduced taxes Status: | DISBURSED on 5/30/2023
Slipip: [202300246
| Address: Check Request [RESO DESK
| Reference [RES # 03955

Impounds | Stub | Comments |

[AS ae Impound #1

| foe
| || Source Fund | Linked | Amount | Tax Year | Status Parcel/Roll:/50359-2068 Dest fund : 026

| } 033 True $156.85 2020 READ CP#H: 0 Reso#: |3555

CP buyer # -[0 Phase #: [313

Moitgagecode: [
< > Transaction #: [RS 03555

Impound Total: 1 Case #: J