STAMPED AND REDACTED - 3700983515 - EDUCATIONAL SERVICES LLC.PDF

Schools Affidavit/Claim Form MAR) COPA
COUNTY
Application for a Duplicate warrant/Check
(deflnHlona 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.
EDUCATIONAL SERVICES LLC (1 ), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 07/16/2026 (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, m: 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
warranttetl1!"Ckcb ·----- 50,873.31 (3)
My commission expires:
12. -·31- J 0·2..,
-.,
;.;..,...,,I (1c•:5;-·V"'(W ,,❖,
Note: Please attach a copy of the warrant/check If available ancil8t1an1,otlmr evidence
that a warrant/check was originally Issued.
Warrant/Check Number
(if knownH6l 3700983515
Original Date of Issue
/if known\ h\ 07116/2026
Reason for original Issue of Warrant/Check (8):
□Payroll
@< For Services or Goods furnished ___________ _
□Other:
S:\Flnan!l!Desk\Sdlools•Warrants 01ed<s notice of dalm.d00<
Revised May 2025 A.Its. 11-632 & 15-999