REDACTED - FOR AGENDA ATTACHEMENT - RYAN CS MCCULLUM #951957.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
Maria Quitangon Me

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

Cathy Sanchez CZ
cathy.sanchez@mari€opa.gov

602-506-7881

Re: Stale Dated Warrant

Name Warrant Amount | Dept/School
No
Ryan CS McCollum 951957 $823.50 | Treasurer

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

This application is for: O Duplicate or Ti] 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.
Rk Yan Lc Lo a vil (1), being first sworn, upon oath deposes and says:
Namd/Claimant
On or about _//-2- 2j22 (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 ee ade sum of $__32 S..82) (3)
Signed: (4)

required) laa Lle of! a

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

Print name:

(5) Subscribed afid)sworn to before me this 3vh day of Marg 2024,

NOTARY PUBLIC

LAURA MARTINEZ
i Notary Public - Arizona
expires: Pinal County
FS oy ‘ Commission # 31772
Quad 1 ni" My Comm. Expires Jul 28, 48@2

My commission

Warrant/Check Number GS / q 5 7

(if known) (6)

Original Date of Issue .

Reason for original issue of Warrant/Check (8):
O Payroll

O For Services or Goods furnished

f Treasurer’s refund/payment

QO Other:
S:\PROCESSES\Warrants ~ Duplicate or Stale\02 Forms\Current Claim Form\100518 Warrants Checks notice of claim.doc
Revised 100518 A.R.S, 11-632 & 11-644
VEE cd
5 lah

Vea

Maricopa County Treasurer's Office 102-19-411 7 5/9/2024 12:20:18 PM
[BB 102-19-411 7 = x
File Help
Year | Description | Act Date | Tran Num | Amount | Images | Pmt Date | Half Code | ActTime A
2022 REDEMPTION PAYMENT 2024-02-20 = 071-77702 $883.02 N 2024-02-14 6:47:00 Ph
2023. TAX PAYMENT 2024-02-20 071-77702 $748.07 N 2024-02-14 F 6:47:00 Ply
2022 CP BUYER PAYMENT 2024-02-06 0987-00077 $883.02 N 2024-02-06 =F 7:53:00 Ph
2022 = =DELINQUENT NOTICE 2023-11-21 Y 12:00:00 4
2023. TAX BILL 2023-08-26 x 12:00:00 4
2022 = DELINQUENT NOTICE 2023-06-01 ¥ 12:00:00 4
2020 REFUND 2022-11-02 $807.06 N 12:00:00 4
2019 REFUND 2022-11-0; $834.02 N :00:
2018 REFUND 20 2 f } me v
< >
Parcel #: [102-19-411 Activity: [REFUND Act Date:{11/02/22
Tax Year: [2018 Tran#:[- fel Act Timei2:00 AM

Activity Detail | Address Detail |

CP #: [78004518
Buyer #: \e787
Fund: 50

Click icon for Disbursements Inquiry. ---->

Check Date: fi 102/22
Check #: [951957
Refund Amount: J $823.50

View Image... Close

Maricopa County Treasurer's Office Refund ID 2022020446 CP_BUYER 5/9/2024 12:21:39 PM

& Refund ID 2022020446 CP_BUYER - a x
File Help
&|B)
Refund Amount: fs823.50 Requester JECHECKWEB on 10/18/2022
Refund Reason: _ [CP Redemption refund Status: [DISBURSED on 11/2/2022

Slip 1D: {202200807

Address: (MCCOLLUM RYAN CS Check Request [MAIL
Reference #: [CP 18004518

wy
~

Impounds | Stub | Comments |

Impound #1
| Source Fund | Linked Amount| Tax Year_| Status Paicel/Roll:[10219-411 Dest fund : 050
| [050 True $823.50 2018  READ| cpy.  [ie004518 Reso: [JD

| CP buyer # [e787 Phase #: jo

Mottgagecode: [-
< > Transaction # : ori 87241
Impound Total: 1 Case tt: |... i