REDACTED - FOR AGENDA ATTACHMENT - HUANDAN LU.PDF

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

E
MARICOPA COUNTY Pn (ee

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

Cathy Sanchez aS

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

Re: Stale Dated Warrant

Name Warrant Amount | Dept/School
No
Huandan Lu 943196 $44.90 | Treasurer

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

This application is for: [1 Duplicate or [ml 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.
Huandan Lu (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 5/12/22 (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 $44.90 (3)

Print name: (required) Huandan Lu

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 _a day of Apo!

Via

NOTARY PUBLIC

VANDANA JOSHI
Notary Public, State of New Jersey
My Commission Expires Jun 14, 2028

My commission expires:

Wesrane chen Number -
(if. known) (6) 9431 96

Original Date of Issue
- (if known) (7) 5/1 2/22

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

QO) For Services or Goods furnished

=) Treasurer's refandipayment

O 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
VERIFIED
y/ lay

Pa

Maricopa County Treasurer's Office 210-12-007A 7

4/11/2024 8:18:29 AM

EEE 210-12-0074 7

Click icon for Disbursements Inquiry. ——>

File Help
Tran Num
213 REFUND M2512 _—_- 44.90
2019. REDEMPTION PAYMENT 2022-05-11 0111-06300 $54.90 N 2022-03-31 3:54:00 PM
2019 +BTX_IMPOUND 2022-04-06  054-97087 $54.90 6:35:00 PM
2019. CP BUYER PAYMENT 2021-02-09 087-00172 $49.90 N 2021-02-09 8:33:00 PM
2019 DELINQUENT NOTICE 2020-12-01 ‘ 12:00:00 AM
2019 TAX PAYMENT 2020-08-10 © 097-02261 $1,866.90 N 2020-08-07 =F 3:53:00 PM
2019 DELINQUENT NOTICE 2020-06-12 Y 12:00:00 AM
2019 = TAX BILL 2019-08-24 Y 12:00:00 AM
< >
Parcel #: [210-12-0074 Activity: |REFUND Act Date{05/12/22
Tax Year: [2079 Tran #:["- fs Act Time/12:00 AM
Activity Detail | Address Detail]
CP # fi 9014677 Check Date: 05/1 2/22 |
Buyer #: [18831 Check #: [943196 |
Fund 60 Refund Amount: $44.50

View Image...

Maricopa County Treasurer's Office

Refund ID 2022010753 CP_BUYER

& Refund ID 2022010753 CP_BUYER = o x
File Help —
HEY
RefundAmount: [$44.90 Requester. JJANETTE.CANCEL on 711/202:

Refund Reason: _ {CP Redemption refund

Status: [DISBURSED on 5/12/2022
Slip ID: {202200337

Address:

Check Request: [MAIL
Reference #: [CP 19014677

fe

Impounds | Stub | Comments |

Impound #1

ParcelV/Roll:[210-12-007A Dest fund : [050
CP #: 19014677 Reso#: [0
CP buyer # :|18831 Phase #: fo

Mortgage code :
Transaction # : fo1106300

| | Source Fund | Linked | Amount | Tax Year | Status
| F oso True $44.30 2013 READ
i
< >
Impound Total : 1

Case #: j

4/11/2024 8:20:45 AM