STAMPED AND REDACTED - 3700875935 - TWISTED ARIZONA.PDF

: ' 
ST A TE OF ARIZONA 
Note: Numbers on this form correspond 10 numbers on the 
COUNTY OF MARICOPA 
Instruction sheet which Is page 2 of this form. 
rw is-tecl Ati1onq /(?.an M 1 , being first sworn, upon oath deposes and says:
Name/Claimant 
On br about 5· 2 9' '2. S 
(date) (2) a warrant/check was Issued 10 the above-named 
person/entity In 1he 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, ru: it was n_ot 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 ls due and owing, and the applicant requests that a replacement 
warrant/ĉ
ed to him/her in the sum of$ 
Signed: 
:::::-:--.., 
& 
Print name: (required) fry= M. cf> ✓ti,.
(5) Subscribed and sworn to before me this '.20
¥aJD  
NOTJ\RYBL
My commission expires: 
1·'2..1· 2ozq 
%] .03 
,(3) 
(4) 
day of MGl'j 
201Ji2.. 
Notary Publlo Stato of ANona 
Mtrlt4pP Counly 
Karl Jex 
Jfy CoMmltalon QRm 2127/;029 
Comm1nlon H1Jmt11ir MllSeal 
Note: Please attach a copy of the warraptlcheck If available and/or any other evidence 
that a warrant/check was originally issued. 
Warrant/Check Number 
lfknown 6 
Original Date of Issue 
If known 
Reason for original Issue of Warrant/Check (8): 
□Payroll
1 
G:rFor Services or Goods furnlshe.,.. 
____________ _ 
D Other: 
S;\RnanalDesl<.\Schools-Warrants Oled<s notice of dahn,docx j
Revi'('!<l May 2025 
A.R,S. ll-632 & IS·999