STAMPED AND REDACTED - 3700959413 - SHEILA MORGAN.PDF

Schools Affidavit/Claim Form
Application for a Duplicate warrant/Check
(definitions are on page 2)
ST COUNTY ATE OF OF ARIZONA MARICOPA Note: Instruction Numbers sheet on which this form Is page correspond 2 of this to form. numbers on the
<YJ O am (&{;.,(I !aim bn nt lad I Gl, (1 ), being first sworn, upon oath deposes and says:
On person/entity or about-˳ In the {1'-\\ZOtio amount as stated (date) below. (2) a Such warrant/check warrant/check was was issued either to the never above-named received or
was being subsequently found or presented inadvertently for payment, lost or QI destroyed it was not and presented there is for no payment reasonable within probabillty one year of after Its
the date of issuance.
Therefore, amount shown under is penalty due and of owing, perjury, and claimant the applicant hereby requests affirms that that a this replacement claim Is correct and the
warran˴˵˶ o him/her in the sum of $,_5..te·.51.ol:u,...,(p"-l_,__ ____ . (3)
Signed: ˷ ˸ (4)
Print name: (required) J3b I R M
before me this _I \˹_day of Sctbbcr20.1.."-.
'."A:, commission expires: • NOTARY JORGE Marlccpa PU8UC GARCIA County - ARIZONA
,,,sf 71c. 2.02'i: comm, Commission Ex . Au # 673439 . 28, 202ll (seal)
Note: that a Please warrant/check attach a was copy originally of the warrant/check issued. if available and/or any other evidence
Warrant/Check If known Number 6 ,3
Original Date if known of Issue 7
Reaso˺ a;YPayroll for original issue of Warrant/Check (8):
D For Services or Goods furnished, ____________ _
D Other:
S:\FlnanceDesk\Schools-Warrants Revised May 2025 Checks notice of clalm.docx A.R.S, 11-632 & 15-999