REDACTED - FOR AGENDA ATTACHMENT - QUIKTRIP CORPORATION 945539.PDF

v
MARICOPA COUNTY

TREASURER’S OFFICE

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

Phone: (602) 506-8511

Fax: (602) 506-1102
http://treasurer.maricopa.gov

To:

From: Treasurer’s Office

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

Maria Quitangon

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

Cathy Sanchez (2
cathy.sanchez@maricopa.gov

602-506-7881

Re: Stale Dated Warrant

Name Warrant Amount Dept/School
No
Quiktrip Corporation 945539 $4,060.23 | 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.

QUIKTRIP CORPORATION _ (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about 07/06/2022 (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.

To the best of our knowledge, the check/warrant was not received and became lost in the mail.

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 $. $4,060.23 .(3)

Signed: (4)
Print name: (required) _G. Harold Christian, VP Operations (Atty-in-Fact)

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 \e™ day of \anvary 20.
SS, ys EWEN! “Wy,

NOTARY PUBLIC SAIS WG 5 ities Me
ce

+4 ‘REGISTRATION NO.” 7 iE
7990776: fE
{MY COMM. EXPIRES:
(04/30(B8)
On RNa, mS

945539 “aya EAS

My commission expires:
-20-Z02le

ee

i

Warrant/Check Number
(if known) (6)

Original Date of Issue
(if known) (7)

07/06/2022

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

OO For Services or Goods furnished

Treasurer's refund/payment
O Other:

S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Current Claim Form\100518 Warrants Checks notice of claim.doc ee?
Revised 100518 A.R.S. 11-632 & 11-644 )e 4
es 40

189768 ded

Maricopa County Treasurer's Office 124-56-100 7 12/6/2023 1:54:49 PM

FB 124-56-100 7 - x
File Help
Year | Description | ActDate | TranNum | Amount | Images | Pmt Date - | Half Code | A
2023 TAX PAYMENT 2023-11-01 = MO A172 $23,600.10 N 2023-10-31 1
2023) TAX BILL 2023-08-26 Y
2022 9 TAX PAYMENT 2023-05-01 =MO A172 $23,303.62 N 2023-04-28 =F
2022. TAX PAYMENT 2022-11-02 MO -A172 $23,303.62 N 2022-10-27 1
2022 TAX BILL 2022-08-20 bd
REFUND 6
2021 RES3RDPARTY REFUND LETTER = 2022-07-05 N
2021 RES IMPOUND 2022-07-05 AS -07545 $4,060.23 N
2021 TAX PAYMENT 2022-07-05 RAS -07545 $22,133.50 N 2022-04-26 F v
< >
Parcel #: [124-56-100 Activity: [REFUND Act Date:|07/06/22
Tax Year: [2021 Tran #: [- [eg Act Time/i2:00 4M

Activity Detail | Address Detail |

CPt or Check Date: jor706/22
Buyer [OO Check #: [945539
Fund 26 Refund Amount: | $4,060.23

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Maricopa County Treasurer's Office
PM

Refund ID 2022014446 RESOLUTION

&. Refund ID 2022014446 RESOLUTION
File Help

JIE

Refund Amount:

[54,060.23
|

Requester, [RESOLUTIONS on 7/5/2022

| Refund Reason: [Resolution has reduced taxes

Status: |DISBURSED on 7/5/2022

Slip 1p: [202200485

| Address:

QUIKTRIP CORPORATION
C/O RYAN

Impounds | Stub | Comments |

Check Request, [RESO DESK

Reference #: [PHASE #00118

Source Fund | Linked | Amount | Tax Year | Statu
1033 True $4,060.23 2021 REAL
|
|
|< >

Impound Total : 1
j
L

Impound #1

Parcel/Roll -[124-56-1 OO Dest fund : }026
CP #: fo Reso ft: {7545
CP buyer # [0 Phase #: |118

Mortgage code: [A172
IRS 07545

Transaction #:

Case #:

12/6/2023 1:55:39