STAMPED & REDACTED UNITED SPIRIT ASSOCIATION.PDF

INTEROFFICE MEMORANDUM
Maricopa County Schools Superintendent Office
TO: CLERK OF THE BOARD
FROM: Terri Ysaguirre
SUBJECT: Affidavits - Replacement of Lost Warrants
. .
DATE: 6/9/2021
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.
v 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.
#95 Queen Creek Unified United Spirit Association $450.00
ate
RECEIVED “bree
JUN 1 2021
MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS

Schools Affidavit/ Claim Form
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.
United Spirit Association (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 12/10/2020 (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 ¢450. 00 (3)
Aum )
Signed: pili fost (4)
Ge
(5) Subscribed and sworn to me this day of 20
NOTARY PUBLIC
My commission expires:
—42740/2020- (seal)
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a watrant/check was originally issued.
Warrant/Check Number
(it known) 3700382090
(6)
06/11/2021
Original Date of Issue j
;
Reason for original issue of Warrant/Check (8):
CL] Payroll
l™ For Services or Goods furnished Cheer Competition
CO Other: Cheer Competition
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc
Revised June 2015 A.R.S. 11-632 & 15-999

CALIFORNIA ACKNOWLEDGMENT CIVIL CODE 8 1189
Anotary public or other officer completing this certificate verifies only the identity of the individual who signed the document
to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
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County of CJC AGE
Date Here Insert Name and Title of the Officer
personally appeared fe LANDES K am FOS TEK
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed
to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their
authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity
upon behalf of which the person(s) acted, executed the instrument.
| certify under PENALTY OF PERJURY under the
laws of the State of California that the foregoing
PHILIP GOZON GONZALES I! paragraph is true and correct.
Notary Pubiic - Ca:ifornia =
Orange County Es 1 WITNESS my hand and official seal.
Commission # 2355751
Ss SAF ag S fe My Comm. Apr 27, 2025 p
Expires Ay
Signature
Place Notary Seal and/or Stamp Above Signature of Notary Public
OPTIONAL
Completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document:
Document Date: Number of Pages:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer’s Name: Signer’s Name:
O Corporate Officer — Title(s): O Corporate Officer — Title(s):
O Partner — O Limited O General O Partner — O Limited O General
O Individual O Attorney in Fact O Individual O Attorney in Fact
O Trustee O Guardian or Conservator 1 Trustee O Guardian or Conservator
O Other: O Other:
Signer is Representing: Signer is Representing:
©2019 National Notary Association

@) unitedspiritassociation
A VARSITY SPIRIT BRAND
February 10, 2021
Queen Creek United School District
Queen Creek AZ 85142
Dear Sir or Madam:
This letter serves a notice that Kimberly Foster has the authority to sign the Schools
Affidavit/Claim Form.
Michael Burgess
President
5770 Warland Drive * Suite B » Cypress, CA 90630 * 800.886.4USA (4872) * 866.761.9365 fax » http://usa.varsity.com