REDACTED - FOR AGENDA ATTACHMENT - RAUL LOPEZ JR_941937..PDF

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

V Phoenix, Arizona 85003
M A R) C Oo PA C Oo U N T Y Phone: (602) 506-8511

TREASURER’S OFFICE

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

Cathy Sanchez 0G

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

Re: Stale Dated Warrant

Name Warrant Amount | Dept/School
No
Raul Lopez Jr. 941937 $86.96 | Treasurer

Application for a Duplicate or Stale-Dated Warrant/Check _

Affidavit/ Claim Form

This application is for: [1] Duplicate or [X] 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.
RAUL. Loz FR, (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about APRIL [3 2042 (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 $ % 6.4G .(3)
Signed: DV wl Ve \ thar (4)
Print name: (required) QACL Lote? a.

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

(5) pivina to before me this ase day of Ociyy_ 20 33.

Zz
NOTARY Pypuc”

My enn expires:

duly, 21 ,av2u

(seal)

== Number a im a2 4

(if known) (6)

oral oate eT open 1 AOR

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

O Payroll

1 For Services or Goods furnished

wt Treasurer's refund/payment

O Other:
S:\PROCESSES\Warrants - Duplicé trent Claim Form\100518 Warrants Checks notice of claim.doc
Revised 100518 RECEIVED ARS. 11-632 & 11-644

OCT 31 2023

MARICOPA COUNTY
TREASURER

Maricopa County Treasurer's Office 102-77-217 2 11/1/2023 10:26:55 AM
FBR 102-77-217 2 - x
File Help

Year | Description | Act Date | Tran Num | Amount | Images | Pmt Date | Half Code | Act A
2023 TAX PAYMENT 2023-10-27 =9MO -F401 $501.12 N 2023-10-27 1 73k
2023. INFO STATEMENT 2023-08-26 N 12:
2023 TAX BILL 2023-08-26 v 12:
2022 TAX PAYMENT 2023-04-25 MO -F401 $470.53 N 2023-04-24 F 8:08
2022 TAX PAYMENT 2022-10-25 MO -F401 $470.53 N 2022-10-25 1 7:58
2022 INFO STATEMENT 2022-08-20 v 12:(
2022 = TAX BILL 2022-08-20 v 12:0
2021 REFUND $90.86 N 12:(

2022-04-13

12.189
< >
Parcel #: fi 02-77-21 Activity: JREFUND Act Date 04/13/22
Tax Year: j2020 Tran# | - Act Times12:00 AM
Activity Detail | Address Detai |
CP #: jo Check Date: joan 3422
Buyer #: fo Check #: [941937
Fund: [26 Refund Amount: $86.96

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Maricopa County
AM

Treasurer's Office

Refund ID 2022008430 RESOLUTION

File Help

CaIey

&. Refund ID 2022008430 RESOLUTION

Refund Amount: [86

96

Requester: JRESOLUTIONS on 4/12/2022

Refund Reason: {Resolution has reduced taxes

Status: JDISBURSED on 4/12/2022

Slip 1D: |202200245

Impounds | Stub | Co

Address: [RAUL LOPEZ JR

Check Request: |RESO DESK

Reference #: |RES #07818

ments |

Impound #1

Source Fund { Linked | Amount | Tax Year | Status
033 True $86.96 2020 READ‘
< >

Parcel/Roll:[102-77-217 Dest fund: [026
cP #: fo Reso: [7818
CP buyer # fo Phase #: 213

Mortgage code : J
JRS 07818

Transaction # :

Impound Total: 1

-—_——_

Case #:

11/1/2023 10:27:13