STAMPED AND REDACTED - 3700995635 - ROSEMARIE SPECE.PDF

Schools Affidavit/Claim Form
Application for a Duplicate Warrant/check
(definitions are on page 2)
ST ATE OF ARIZONA Note: Numbers on this form correspond to numbers on the
COUNTY OF MARICOPA Instruction sheet which Is page 2 of this form.
_RˉO,...S_E_M=A,...R,...I_E.. ,S_P_E_C_E ____ (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about OB/1112°26 (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
. (3)
Print name: (required) .:..R_O_S_E_M_A_R_IE_S_P_E_C_E __ ______ _ _
(5) Subscribed and sworn to before me this -ˊ-day of .S e:pi embw1C.2..4'
NOTARY PUBLIC OFFICIAL SEAL
NOTARY ASHLEY PUBLIC SANCHEZ ,ARIZONA
MARICOPA COMM#690131 COUNTY
y Camm. Explros Sap!, 30, 2(128 (seal)
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 3700995635
(If known) (6)
Original Date of Issue
(If known) (7) 08/11/2026
Reason for original issue of Warrant/Check (8):
l!!l Payroll
□For Services or Goods furnishe...__ ____________ _
□Other:
S:\F!nanceDesk\Schools-Warrants Checks notice of dalm.docx
Revised May 2025 A.R.S. 11-632 & 15-999