STAMPED AND REDACTED- 3700914492 - PHX BUBBLE BINZ.PDF

Schools Affidavit/Claim Form 
Application for a Duplicate Warrant/Check 
( deflnl11ons are on page 2) 
11 
Note: Numbers on this form correspond to numbers on the 
Instruction sheet which Is page 2 of this form.
/ STATE OF ARIZONA 
COUNTY OF MARICOPA 
Phx Bubble Binz LLC (1 ), being first sworn, upon oath deposes and says: 
Name/Claimant 
On or about 10/17/2025 
(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 probablllty of Its 
being found or presented for payment, QI It was not presented for payment within one year after 
the date of Issuance. 
, Jherefore, under penalty of perjury, claimant hereby affirms that this clalm Is correct and the 
r amount shown Is due and owing, and the applicant requests that a replacement 
I 
warrant/check be Issued to him/her In the sum of $,_1...f_,_9_2_0_. 0_0 ___ Ȼ (3) 
Signed:ȼ ..=:..:x:: - r{)e,[111:z_.e.r 
print name: (req:Ui:: H(}\rJ;nyr 
••
NOTARY PUBLIC
My c-<f nwsion expires:
·'--1-Ƚ 
(4)
(seal) 
F' Note: Please attach a copy of the warrant/check if available and/or any other evidence 
that a warrant/check was originally Issued. 
Warrant/Check Number 
/if knownl 16l 
Original Date of Issue 
' 
(If known \/7\ 
3700914492 
10/17/2025 
Reason for original issue of Warrant/Check (8): 
D Payroll 
D For Services or Goods furnlshe...._ __________ _ 
r·  Other: 
S:\FlnanceDesk\Schools-Warrants Checks notice of clalm,docx 
Revised May 2025 
A,R,S, 11-632 & 15-999