REDACTED - FOR AGENDA ATTACHMENT - CAROL A. MACK_CHRISTOPHER J. MACK_945555.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

Maria Quitangon -<—
maria.quitangon@maricopa.gov
602-506-1958

Cathy Sanchez CF7

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

Re: Stale Dated Warrant

Name Warrant Amount | Dept/School
No

Carol A Mack 945555 $269.84 | Treasurer

Christopher J Mack

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

1B OCT 11 AM 9:07

This application is for: O Duplicate or E¥stale-Dated (definitions are on page 2)

STATE OF ARIZONA Note: Numbers on this form correspond to numbers on the
wey OF MARICOPA Instruction sheet which is page 2 of this form.

Cara lh OME $i tehenL) Méc. (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about Lily 6 _Z0ZZ _ (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 $ ALL SE .(3)

sired: Ce A Freek Oyo) frtah
Print name: (required) al Gl Q Mit U (De phe ( Mack

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

" Ajow7e and sworn to Zep me this "it day of war hor 202%.

NeraRy _Naraky Pp BLIC
¢ FER. SUZANNE BODROGI
Notary Public - Ari
My (pes ia WE ‘© Maricopa County
( “ Y Commission # 629545 (seal)

SE” My Comm, Expires Jun 14, 2026

Warrant/Check Number /
(if known) (6) g. 4G. 5-5-5
Original Date of Issue :
7 (if known) (7) 7 of. 2022
Reason for original issue of Warrant/Check (8):
O Payroll

CO For Services or Goods furnished

C1 Treasurer's refund/payment

th other; 202! “Tay Resolution om Purcel S08 -SP- TER pa Te

: ‘t Claim Form\100518 Warrants Checks notice of claim.doc
tient dalam Duplicate or Stale\02 Forms\Current Claii \; 2S Oa ey me 11-644

es
ye aie
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Maricopa County Treasurer's Office 503-53-762 6 10/18/2023 8:00:04 AM
[BB 503-53-762 6 _ %
File Help
Year | Description | Act Date | Tran Num | Amount | Images | Pmt Date | Half Code | Act A
2023. TAX PAYMENT 2023-08-28 086-20748 $648.03 N 2023-08-28 1 9:3E
2023 BILL PRINT 2023-08-26 Y 12:(
2022 TAX PREPAYMENT 2023-03-02 075-58485 $648.03 N 2023-03-01 6:3¢
2022. TAX PAYMENT 2023-03-02 0075-58485 $1,146.62 N 2023-03-01 -F 6:3¢
2022 TAX PAYMENT 2022-10-27 —072-37891 $1,146.62 N 2022-10-24 1 Alt
2022. TAX BILL 2022-08-20 v 12:(
REFUND Im ‘ 2

2021 RES REFUND LETTER 2022-07-05 N 6:4:
2021 RES IMPOUND 2022.07-05 AS -07092 $269.84 N BA
< >
Parcel #: [503-53-762 Activity: JREFUND Act Date:J07/06/22
Tax Year: (2021 Tran #: [- ie Act Time{i2:00 AM

Activity Detail | Address Detail |

CP #: jo Check Date: jo7/06/22
Buyer #: jo Check #: [945555
Fund: [26 Refund Amount: | $269.94
Click icon for Disbursements Inquiry. -----> af

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Maricopa County Treasurer's Office
AM

Refund ID 2022014437 RESOLUTION

&, Refund ID 2022014437 RESOLUTION
File Help

elle

Refund Amount: fs2ea.sa

Requester, [RESOLUTIONS on 7/5/2022

Refund Reason: |r esolution has reduced taxes

Status: [DISBURSED on 7/5/2022

Slip 1D: [202200485

Address: [CAROL A MACK
CHRISTOPHER J MACK

Check Request: [RESO DESK

Reference #: |RES #07092

Impounds | Stub | Comments |

Impound #1

| | Source Fund | Linked | Amount | Tax Year | Status
| 033 True $269.84 2021 READ
|

< >

Parcel/Roll :|503-53-762 Dest fund : |026
CP #: oO Reso: [7092
CP buyer # :/0 Phase #: [ne

Mortgage code: [

Transaction #: JAS 07092

Impound Total : 1

Case #: [tS

10/18/2023 7:59:54