STAMPED AND REDACTED - 3700964244 - GLENDALE UHSD.PDF
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Schools Affidavit/Claim Form Application for a Duplicate Warrant/Check (definitions nro on page 2) STATE OF ARIZONA COUNTY OF MARICOPA Note: Numbers on this form correspond to numbers on the Instruction sheet which Is page 2 of this form. ....:G..:.le;;--nc.cd..:.a-c,l..:.e_Uc...Hc.;...cS..::D_·C .;....;.T.:cE'--_ (1 ), being first sworn, upon oath deposes and says: Name/Glalmanl On or about 04/29/2026 (date) (2) a warrant/check was Issued to the above-named person/entity In the amount as stated below. Such warranl/oheck 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, Qt 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 warra̪ cl!eQste̫̬ r In the sum of s 100,607.27 • (3) Slgned:̭ --6 - ......,""""''-"".,..,_"""'"-=-̮ ---̯ ----<4) Print name: (required̰̱ OJ}\614 I ! 'TI \ " I - (5) S bscrlbed and sworn to before me this ̲̳ -day ok U...11) :e., 20."'-le, My mission expires: N 0:11-g.Wi,6̴ C 3 1 :J 02-7 ®. lllwilW£. RW lkoia MmCO!'A COUITTY .LbOIIMISSI0/1 I 6591112 ____ .. .._w_,,.,. __ ,U!lm .,,_,..llrf;,;;,mbe ....;r3;,;,'lfll1 ;;...̵ •ai) 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 3700964244 (If knownl (6) Original Date of Issue 04/29/2026 /If knownl 17) Reason for original issue of Warrant/Check (8): D Payroll □For Services or Goods furnished ____________ _̶ Other: S:\FlnanceDosk\Schools-Wammts Checks notice of claim,doc@ Revised May 202.5 A.R,S. 11·632 & 15•999