REDACTED - FOR AGENDA ATTACHMENT - CLEAR TITLE AGENCY.PDF

v
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 Col
cathy.sanchez@maricopa.gov

602-506-7881

Re: Stale Dated Warrant

Name Warrant Amount | Dept/School
No
Clear Title Agency 944914 $946.27 | Treasurer

Application for a Duplicate or Stale-Dated Warrant/ Check

Affidavit/Claim Form

This application is for: oO Duplicate or {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.

C\ \EQAY. Whe. BOP), being first sworn, upon oath deposes and says:
Name/Claimant

On or about Wl ge) 101 (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 $ Y Hy. 1 -(3)
Signed: ZES 2 kk — (4)
Print name: (required) Dunant Traces

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

(5) Subseribed and i Dl me this__\“**_day of Cura oe 20.235

enn dit.

KATIE BOYD

My commission expires:

ary 24 HaT

Commission # 597422
Expires March 20, 2025

(seal)
Warrant/Check Number 1
(if known) (6) aI Le UY 4 l ~
Original Date of Issue |
(if known) (7) Y [20 22
Reason for original issue of Warrant/Check (8):
O Payroll
O For Services or Goods furnished
‘Mf 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 ARS. 11-632 & 11-644 y©

August 17, 2023

Maria Quitangon

TREASURER’S OFFICE

BUSINESS OPERATIONS

301 W Jefferson St Suite 100 Phoenix, AZ 85003
Management Analyst

O: 602-506-1958

Dear Maria:

This letter hereby authorizes Shannon Doetsch to sign the Affidavit/Claim form. She is an
authorized person to make this claim.

Sincerely,

ey \nse iced oe

Chassity Burks

CLEAR TITLE AGENCY of Arizona Phoenix/Biltmore

Maricopa County Treasurer's Office 504-75-748 6 8/24/2023 12:42:35 PM
[BR 504-75-748 6 - x
File Help
Year | Description | Act Date | Tran Num | Amount | Images | PmtDate | Half Code La
2022 TAX PAYMENT 2023-01-03 =O -NO10 $1,929.84 N 2022-12-28 F
2022) TA BILL 2022-08-20 ¥
REFUND Zi | - +4 i
2021 CT IMPOUND 2022-05-05 0565-35231 $946, v
2021 TAX PAYMENT 2022-04-28 = MO -FO24 $946.27 N 2022-04-28 F
2021 TAX PAYMENT 2021-10-26 =MO -FO24 $946.27 N 2021-10-22 1
2021 INFO STATEMENT 2021-08-21 v
2021 TAX BILL 2021-08-21 Y
2020 TAX PAYMENT 2021-04-26 MO -F024 $861.14 N 2021-04-22 F ¥
<5 — geen ARTY s
Parcel #: [504-75-748 Activity: [REFUND Act Date:06/20/22
Tax Year: [2021 Tran #:[- at Act Time {12:00 AM
Activity Detail | Address Detail |
CP #: i Check Date: {06/20/22
Buyer #: jo Check #: [s44gi4
Fund: [26 Refund Amount: J $946.27

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Maricopa County Treasurer's Office

Refund ID 2022013213 MANUAL

By Refund ID 2022013213 MANUAL
File Help

CaIey

| Refund Amount, [$946.27

Requester, [DELIA BORUNDA on 6/17/2022

| Refund Reason: |Overpayment of property taxes

|
|

Status: [DISBURSED on 6/17/2022

Slip ip: [202200441

Address: Cy

Impounds | Stub | Comments |

Check Request: [MAIL

Reference #: |

Impound #1

Amount | Tax Year | Status

| Source Fund | Linked |
| | 064 True $346.27 2021
| |<

READ

Parcel/Roll :/504-75-748 Dest fund : [026
CP#: a Reso#: (0
CP buyer # :/0 Phase #: |0

Mottgagecode: [

Impound Total: 1

Transaction #: [05535231
Case #:

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8/24/2023 1:18:38 PM