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INTEROFFICE MEMORANDUM
Maricopa County Schools Superintendent Office
TO: CLERK OF THE BOARD
FROM: Terri Ysaguirre
SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 1/11/2021
Please find attached 1 Affidavit/Notice of Claim(s) for lost warrants for inclusion on the next
available Board agenda
Vv The attached item(s) have been researched to ensure that the warrant(s) in question have
not been cashed or previously re-issued.
Vv The original warrant(s) have had a stop payment done.
If you have any questions, please contact Terri Ysaguirre at 602-372-1245 or via e-mail at
terri.ysaguirre@maricopa.gov. Approved Affidavits may be routed back to the Superintendent
of School Finance Division at 4041 N. Central Avenue #1200, (12th Floor)
Thank you.
#216 Agua Fria Union Gipper Media Inc $450.00
RECEIVED Fone
JAN 12 2021
MARICOPA COUNTY
GLERK BOARD OF SUPERVISORS
Application for a Duplicate or Stale-Dated Warrant/ Check
Affidavit/ Claim Form
This application is for: [ml Duplicate or L_] Stale-Dated (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.
Gipper Media, Inc. (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 07/23/2020 (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
warrant/check be issued to him/her in the sum of $490.00 (3)
BA aa
Wd
Signed: ;
Note. Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
State of Florida, county of Clay
(5) Subscribed and sworn to before me this ; 28th day of December 2020
by Matthew Glick who provided a,CA driver's license for identification.
Yoball. Alor
NOTARY PUBLIC Michelle Acker
MICHELLE ACKER
Notary Public - State of Florida
Commission # Ht33601
My commission expires: Expires on August 18, 2024
08/18/2024 (seal)
Notarized online using audio-video communication
Warrant/Check Number
3700339403
yGrieck Ni
Original Date of Issue 07/23/2020
Date of |s
Reason for original issue of Warrant/Check (8): pare JAN 1.2, 2021
0 Payroll
pay
Paani
=| For Services or Goods furnished a (
L] Treasurer’s refund/payment
L] Other:
S:\PROCESSES\ Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc
Revised April 2015 A.R.S. 11-632 & 11-644
GIPPER MEDIA, INC.
728 20" Street, Santa Monica, CA 90402 . Sisliv ef:
{
ry JAN 04 2021 73
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Dear Sir or Madam, By:
pas
On or about July 23, 2020 a check was issued by (or on behalf of) Millenium High School to Gipper
Media, Inc. (the “Company”) in the amount of $450 for services. Such check was never received.
The signer of the enclosed Affadavit/Claim Form, Matthew Glick, is the CEO and an officer of the
Company who is authorized to sign such documents on the Company’s behalf.
The Company looks forward to receiving the replacement check. Thanks in advance for your prompt
attention to this outstanding matter.
Very truly yours,
GIPPER MEDIA, INC.
By: Steven Glick
Title: Secretary