STAMPED AND REDACTED - 3700954338 - THE ACES.PDF

Schools Affidavit/Claim Form MAR COPA
COUNTY
Application for a Duplicate Warrant/Check
(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.
The Austin Centers for Exceptional Students (1 ), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 03/19/2026 (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
'm/her in the sum of $,_6_,5_3_6_.0_0 _____ . (3)
Print name: (required) Lisa D'Angelo for Austin Centers
I 3 day of
1kt-l cg
Notary Public Stat• ot Arizona
Maricopa County
My commission expires: My Stacey Commlnlon MacGregor ElCPlrM 277/2030
Vb :J, @,ajl) CommlHlon Number 881680 I)
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
3700954338
(if known) (6)
Original Date of Issue
03/19/2026
(if known) (7)
Reason for original issue of Warrant/Check (8):
□Payroll
□For Services or Goods furnished _____________ _
Ii! Other: Transportation Services for February 2026, Invoice Tr-03763
S:\FinanceDesk\Schools-Warrants Checks notice of claim.docx
Revised May 2025 A.R.S. 11-632 & 15-999