REDACTED - FOR AGENDA ATTACHMENT - RAUL LOPZ JR_941942.PDF

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MAR\COPA 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 (a
maria.quitangon@maricopa.gov
602-506-1958

Cathy Sanchez cD
cathy.sanchez@maricopa.gov
602-506-7881

Re: Stale Dated Warrant

Name Warrant Amount | Dept/School
No
Raul Lopez Jr. 941942 $97.79 | 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.
QAVL Lofer OR (1), being first sworn, upon oath deposes and says:
Name/Claimant .
On or about Af@ic (> 26) (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 $ g 4 4 A .(3)

Au ) | spore
Signed: (how YA (4)
Print name: (required) QADL Lofc? 5h

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

NOTARY PUBL!

(5) Sub we me this 31 ** day of OChou 202%.

My commis: ‘en expires: lt ie
ual ae a1, 202

(seal)

Warrant/Check Number

(if known) (6) | 4 4 42

Original Date of Issue

(if. known) (7) APRIL 13 EN

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

O Payroll

O 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
Revised 100518 RECEIVED A.R.S, 11-632 & 11-644

OCT 31 2023

MARICOPA COUNTY
TREASURER

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Maricopa County Treasurer's Office 102-77-217 2 11/1/2023 10:24:30 AM
FBR 102-77-217 2 - x
File Help

Year | Description [Act Date | TranNum | Amount | Images | Pmt Date | Half Code | Act A
2023 INFO STATEMENT 2023-08-26 N 12:0
2023 TAX BILL 2023-08-26 Y 12:0
2022 TAX PAYMENT 2023-04-25 MO F401 $470.53 N 2023-04-24 F 8:0f
2022. TAX PAYMENT 2022-10-25 MO -F401 $470.53 N 2022-10-25 1 7:58
2022 INFO STATEMENT 2022-08-20 Y 12:(
2022 TAX BILL 2022-08-20 Y 12:
2021 REFUND 2022-04-13 $90.86 N 12:
2020 REFUND $86.96 N

REFUND

2022-04-1

Click icon for Disbursements Inquiry.

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Parcel #: 102-77-217 Activity: [REFUND Act Date:04/13/22
Tax Year: 2079 Tran #: [- fe Act Time {12:00 AM
Activity Detail | Address Detail |
cP t: c.|.OFO™~;~™S Check Date: [04/13/22
Buyer tt: c.)TFTFTOt~™™ Check #: [941942
Fund: [6 Refund Amount: $97.79

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Maricopa County
AM

Treasurer's Office

Refund ID 2022008426 RESOLUTION

Source Fund | Linked | Amount | Tax Year | Status
033 True $97.79 2019 READY
< >

Impound Total : 1

Impound #1

Parcel/Roll )102-77-217 Dest fund : }026
cP #: fo Reso #: Jace86

& Refund ID 2022008426 RESOLUTION x

File Help

EIEY
RefundAmount: [$87.79 Requester, [RESOLUTIONS on 4712/2020
Refund Reason: |Resc lution has reduced taxes Status: [DISBURSED on 4/12/2022 |
Slip 1D: [202200244 |
Address: [RAULLOPEZ JR Check Request: JRESO DESK
Reference #: JRES # 36686 |
series ms
Impounds | Stub | Comments |

a

CP buyer # Jo

Mortgage code : ]

Transaction # :

Case #:

Phase #: [352

JrS 36686

11/1/2023 10:24:17