REDACTED - FOR AGENDA ATTACHMENT - FIDELITY NATIONAL TITLE AGENCY_REDACTED.PDF
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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 Mw
Maria Quitangon
maria.quitangon@maricopa.gov
602-506-1958 A
Cathy Sanchez
cathy.sanchez@maricopa.gov
602-506-7881
Re: Stale Dated Warrant
Name Warrant Amount | Dept/School
No
Fidelity National Title Agency 947595 196.00 | Treasurer
Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: O Duplicate or N Stale-Dated (definitions are on page 2)
STATE OF ARIZONA Note: Numbers on this form correspond to numbers on the
ails OF MARICOPA Instruction sheet which is page 2 of this form.
—+— | -
ot TD Ay ALA = Hide \ tyca} being being first sworn, upon oath deposes and says:
‘Name/Claimant
On or about didznez= (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 tly in the sum of $ \q la, GO .(3)
Signed: XY (4)
Print name: (rephiredy_—] Tp) AYALA ; Aldnagee Fidelur
Note, Please attach a copy of the warrant/check if avaiable and/or any! bie
evidence that a warrant/check was a issued.
©) ae, and sworn to before me this TF ay of “Levent ZZ
WUT COpezesex
sia PUBLIC i ancien WAND
M y Nota Ole | gabis
ly commissionyexpires: 5] Maricopa Co. / #or
pa iraks Rag” Expires 06/16/2027 (seal)
Warrant/Check Number =
(if known) (6) q 4 7 YS
Original Date of Issue j
(if known) (7) al YiZore—
Reason for original issue of Warrant/Check (8):
O Payroll
0 For Services or Goods furnished
ys Treasurer's refund/payment 2ZOZ.| fFaxcs — Qk 2 HitheA
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
yrs
ws
po—
Jodi Ayala
Assistant Vice President
Branch Manager
Escrow Officer
od
PRESIDENT’S CLUB
HALL OF FAME
Fidelity National Title Agency
Maricopa County Treasurer's Office
173-53-419 8
12/12/2023 11:14:04 AM
EE 173-53-419 8
File Help
- { x
Year | Description | Act Date | Tran Nur |
Amount | Images | Pmt Date | Half Code | Act Time | cal
2023 TAX BILL 2023-08-26
2022) TAX BILL 2022-08-20
2022-08-18
2023) TAX PAYMENT 2023-09-22 050-55718
2022 TAX PAYMENT 2022-11-18 — 052-85713
2021 = =CTXIMPOUND 2022-05-04 0565-33377
$191.88 ¥ 2023-09-21 1
Y
$364.10 Y 2022-11-17 =F
ae
< N
$196.00
6:39:00 PM
12:00:00 AM
6:31:00 PM
6:38:00 PM
Activity Detail | Address Detail |
Y
2021 TAX PAYMENT 2022-04-28 MO -F454 $193.42 N 2022-04-28 F 8:23:00 PM
2021 TAX PAYMENT 2021-10-26 =MO -F454 $193.42 N 2021-10-22 1 8:36:00 PM
2021. INFOSTATEMENT = 2021-08-21 Y 12:00:00 AM ¥
< >
Parcel #: [173-53-419 Activity: REFUND Act Date08/18/22
Tax Year: 2027 Tran #:[- ey Act Time {12-00 4M
CP #: fo
Buyer #: fo
Fund: [26
Click icon for Disbursements Inquiry. ----->
Check Date: [09/18/22
Check #: J 947595
Refund Amount: | $196.00
View Image... Close
Maricopa County Treasurer's Office
Refund ID 2022017569 MANUAL
&, Refund ID 2022017569 MANUAL
File Help
Cae
| Refund Amount: {si 96.00
Requester: |RHINA.CANJURA on 8/17/2022
Refund Reason: {Overpayment of property taxes
Status; [DISBURSED on 8/17/2022
Slip ID: |202200606
Address: FIDELITY NATIONAL TITLE AGENCY
ESCROW NO. 57010752 - 057 JA1
Impounds | Stub | Comments |
Check Request: |RHINA
Reference #: |
Impound #1
Source Fund | Linked | Amount | Tax Year | Status
064 True $196.00 2021 READ
< >
Parcel/Roll:|173-53-4139 Dest fund : |926
CP#: oO Reso #: fo
CP buyer # :/0 Phase #: [0
Mortgage code :
Transaction #: — |05533377
Impound Total : 1
Case #:
12/12/2023 11:13:55 AM