REDACTED - FOR AGENDA ATTACHMENT - SCOTT UNDERWOOD #955198.PDF

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

l,
MA R) COPA COUNTY Ce a weit,

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

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

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

Cathy Sanchez Cs,

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

Re: Stale Dated Warrant

Name Warrant Amount | Dept/School
No
Scott Underwood 955198 $2,186.65 | Treasurer

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

i)

Co UNS

This application is for: oO Duplicate or XM 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.

Sead. Underwood (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about 3/ 10 / 23 (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 $__2 yA ¥b.45 .(3)
deott Anthony Underwood
Signed: (4)

Scott Anthony Underwood

Print name: (required)

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

~) Subscribed and sworn to before me this___6th__day of ___June 2024
y Scott Anthony Underw

Notary Public, State of Texas

NOTARY PUBLIC

John D Clark

10 NUMBER
19240917-9
COMMISSION EXPIRES

My commission expires:
03/18/2028

March 18, 2028 (seal)
Warrant/Check Number
(if known) (6) 455 143
Original Date of Issue
(if known) (7) 3/io/23
Reason for original issue of Warrant/Check (8):
O Payroll
0 For Services or Goods furnished
Gk Treasurer’s refund/payment +a y ¢eca\witem ow pucce\ W-40-Oay
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

Electronically signed and notarized online using the Proof platform.
VERIFIED
é)ehag M*

Maricopa County Treasurer's Office

111-40-028 1 6/6/2024 9:01:20 AM

fl 111-40-028 1
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Click icon for Disbursements Inquiry. ----->

Act Date Act A
RES REFUND LETTER - N :
RES IMPOUND 2023-03-09 AS -02802 $2,186.65 N 6:3)
TAX PAYMENT 2023-03-09 RS -02802 $641.86 N 2022-09-27. FF 6:3.
POST NEW TAX (RESOLUTION) 2023-03-09 AS -02802 $641.86 N 6:3
CANCEL TAX 2023-03-09 RS -2802 $5,502.34 N 6:3)
RESTORE TAX 2023-03-09 AS -02802 $2,751.17 N 1 63)
RESOLUTION REPRINT 2023-03-09 ¥ 12:
TAX PAYMENT 2022-09-30 072-19245 $2,751.17 N 2022-09-27. 1 bv
< >
Parcel #: [111-40-028 Activity: REFUND Act Date:03/10/23
Tax Year: [2022 Tran #:[- fg] Act Time‘{i2:00 AM
Activity Detail | Address Detail |
| : ey Me eee Se ee el ea a eal
| CP #: jo Check Date: jos 0/23
| Buer#: [0 Check #: [955798
|
| Fund: j26 Refund Amount: $2,186.65

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Maricopa County Treasurer's Office Refund ID 2023003923 RESOLUTION 6/6/2024 9:00:56 AM

&. Refund ID 2023003923 RESOLUTION = oO x
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SQ)
Refund Amount: [$2,186.65 Requester, [RESOLUTIONS on 3/9/2023
Refund Reason: [Resolution has reduced taxes Status: {DISBURSED on 3/9/2023

Slip|D: [202300129

Address: SCOTT Check Request: |RESO DESK
Reference #: [RES # 02802

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Impounds | Stub | Comments |

Impound #1

fii7-40-028 — foe |

Source Fund | Linked | Amount | Tax Year | Statu Parcel/Rol :|111-40-028 Dest fund : }026 |
033 True $2,186.65 2022 REAL CPH: o Reso tt: [2802

CP buyer # Jo Phase # : fos

Mortgage code: |
«< > Transaction #: [RS 02802
Impound Total : 1 Case #: I