REDACTED - FOR AGENDA ATTACHMENT - ERICA DAY.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
cathy.sanchez@maricopa.gov
602-506-7881

Re: Stale Dated Warrant

Name Warrant Amount | Dept/School
No
Erica Day 941372 $40.57 | Treasurer

Application for a Duplicate or Stale-Dated Warrant/Check

Affidavit/Claim Form Ouns,
This application is for: oO Duplicate or [<icie-detea (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.
(Aa A OAT (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about _¥/(/2> (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 higher in the sum of $ +D. SH .(3)
= - ay oe
Signed: = a Fen St. Lu. (4)

Print name: (required) «CR P ©, DAY

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

ain to before me this Keen day of beget 207.

N@TARY PuBtic

SHAWN DOERRER
oo : Notary Public
My commission expires: St. Mary's County, Maryland
Nalz0 1s My Commission Expires 7/19/2026 (seal)
Warrant/Check Number
(if known) (6) GI13 FQ
Original Date of Issue
(if known) (7) vi / | / ‘Ris
Reason for original issue of Warrant/Check (8):
OO Payroll

O) For Services or Goods furnished
Treasurer's refund/payment TA< ¢@16~ Arr END)
Other: CP Gvryt& dF 43024 Foe fvechws€ (&d1977%

S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Current Claim Form\100518 Warrants Checks notice of claim.doc ¢ 169
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Maricopa County Treasurer's Office 302-05-740 5 8/24/2023 1:21:41 PM
FR 302-05-740 5 = x
File Help

Year | Description | Act Date | Tran Num | Amount | Images | Pmt Date { Half Code | Act Time A
2022 TAX PAYMENT 2023-04-25 MO -F576 $785.32 N 2023-04-24 F 8:59:00 Ply
2022 TAX PAYMENT 2022-10-25 MO -F576 $785.32 N 2022-10-25 1 8:50:00 Ply
2022 INFO STATEMENT 2022-08-20 Y 12:00:00 4
2022 TAX BILL 2022-08-20 v 12:00:00 4

TAX PAYMENT 2022-04-28 MO -F576 $806.02 N 2022-04-27 — F 9:30:00 Phe

E 4-011 - N 1 é

REDEMPTION PAYMENT = 2022-03-31 = 011-05112 $50.57 N 2021-08-16 4:35:00 Ph

TAX PAYMENT 2021-10-26 MO -F576 $806.82 N 2021-10-22 1 9:11:00 Pl

INFO STATEMENT 2021-08-21 Y 12:00:00.4 v
< >

Parcel #: (302-05-740 Activity: [REFUND Act Date}04/01/22
Tax Year: [2016 Tran #[- | Act Time/i2.00 4M
Activity Detail | Address Detail |
cP #: fr6013948 Check Date: [04/01/22
Buyer #: [7300 Check #: [941372
Fund: 50 Refund Amount: $40.57
Click icon for Disbursements Inquiry. -----> Ee
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Maricopa County Treasurer's Office

Refund ID 2022007592 CP_BUYER

&. Refund ID 2022007592 CP_BUYER
File Help

EaIey

| Refund Amount:

Requester, JJANETTE.CANCEL on 3/31/202.

jcr Redemption refund

Refund Reason:

Status: [DISBURSED on 4/1 42022

Slip 1D; [202200219

Address:

Impounds | Stub | Comments |

Check Request [MAIL
Reference t: [CP 16013948

| Impound #1
Source Fund | Linked | Amount | Tax Year | Status Parcel/Roll:|302-05-740 Dest fund ; |050
050 True $40.57 2016 READ'| copy: fie013040 Reson: fo
CP buyer #: 7320 Phase #: f
Mortgage code: [
BS > Transaction # : Jjonosizttst—~S

Impound Total: 1

we

Case #:

8/24/2023 1:22:10 PM