REDACTED - FOR AGENDA ATTACHMENT - ELENA SHORB 947621.PDF

L
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: Clerk of the Board
clerk.agenda@maricopa.gov

Dorene.Stretar@Maricopa.Gov

From: Treasurer's Office
Maria Quitangon

602-506-1958

Cathy Sanchez a)
cathy.sanchez@maricopa.gov

602-506-7881

Re: Stale Dated Warrant

yw

maria.quitangon@maricopa.gov

Name Warrant Amount | Dept/School
No
Elena Shorb 947621 $596.92 | Treasurer

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

This application is for: Oo Duplicate or [tale-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.
Zlend Shovlo (1), being first sworn, upon oath deposes and says:
Name/Claimant ;
On or about __& |\Q { LOZVL (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 $_ 5 (4.4% 2 -(3)

Signed: 62 0z— (4)

Print name: (required) Siena S horle

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 _/27 day of _Crarmnry 2024.

NOTARY PUBLIC _"
d | SE, “DAVID MICHAEL DE LA OSSA
<<) NOTARY PUBLIC - ARIZONA
Maricopa County
Commission # 624458
My Commission Expires
December 14, 2025

My commission, expires:
Ir L L f 25

Warrant/Check Number
‘ known) (6) Hoel A472
Original Date of Issue 7
ae (fiw) Sheet 8) 14/7.

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

OO For Services or Goods furnished
(Treasurer's refund/payment refs for nev MENT ov) Dar tl (3|-0F- oH

O Other:

S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Current Claim Form\100518 Warrants Checks notice of claim.doc 4
Revised 100518 ARS. 11-632 & 11-644 yer rr “wl

Maricopa County Treasurer's Office 131-07-207C 1 1/30/2024 8:16:55 AM

PM] 131-07-207C 1 - x

File Help
Year | Description | Act Date | Tran Num | Amount | Images | Pmt Date | Half Code | ActTime = A
2023 TAX PAYMENT 2023-09-22 = 072-14529 $1128.14 N 2023-09-19 F 6:30:00 PM
2023) INFO STATEMENT 2023-08-26 N 12:00:00 4M
2023) TAX BILL 2023-08-26 vY 12:00:00 4M
2022 TAX PAYMENT 2023-04-25 =O -Fo?4 $536.50 N 2023-04-24 F 8:54:00 PM
2022 9 TAX PAYMENT 2022-10-25 MO -For4 $536.50 N 2022-10-25 1 8:44:00 PM
2022 INFO STATEMENT 2022-08-20 v 12:00:00 4M
2022 TAX BILL 2022-08-20 ae 12:00:00 4M

2022-08-15

055-50670 J2 ¥

2021 CT IMPOUND 32:00 PM ¥
< >
Parcel #: [131-07-207C Activity: REFUND Act Date:08/19/22
Tax Year: [2021 Tran #:[- (| Act Time:f12:00 AM
Activity Detail | Address Detail |
CP #: fo Check Date: {081 9/22
Buyer #: fo Check #: [947621
Fund: [26 Refund Amount: $596.92
Click icon for Disbursements Inquiry. -----> =

View Image... Close

Maricopa County Treasurer's Office

Refund ID 2022017635 MANUAL

&. Refund ID 2022017635 MANUAL
File Help
4

| Refund Amount; [$596.92 ;

Requester:

Refund Reason: [Overpayment of property taxes

Status: |DISBURSED on 8/18/2022

Slip 1; {202200611

Address:

Impounds | Stub | Comments |

Check Request: [MAIL

Reference #: |

Source Fund [ Linked | Amount | Tax Year | Status
064 True $596.92 2021 READ
< >

Impound Total : 1

Impound #1

Parcel/Roll fi 31-07-2070 Dest fund : fo26
CP#: jo Reso #: fo
CP buyer # fo Phase #: [0

Mortgage code: [
Transaction #: — |05550670
Case #:

|RAMONA. MORAN on 8/18/2022

1/30/2024 8:18:34 AM