STAMPED & REDACTED MIGUEL MENDOZA MARTINEZ.PDF
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INTEROFFICE MEMORANDUM Maricopa County Schools Superintendent Office RECEIVED 09 4\ © TO: CLERK OF THE BOARD JUN 09 2021 ae Terni Wsagulrre MARICOPA COUNTY CLERK BOARD OF SUPERVISORS SUBJECT: Affidavits —- Replacement of Lost Warrants DATE: 6/7/2021 Please find attached 1 Affidavit/Notice of Claim(s) for lost warrants for inclusion on the next available Board agenda v 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. #60 Higley Unified Miguel Mendoza Martinez $1,057.99 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 Instruction sheet which is page 2 of this form. COUNTY OF MARICOPA Miguel Mendoza Martinez (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 9/1/2021 (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 $ 1,057.99 (3) Signed: Ls Lasel (4) Bieta Wn and sworn to before me this H day of Une 20n| . ( WW Yn Nea NOTARY PUBLIC Kreme Notary Public - Arizona | E| (SS) JZ, MARICOPA COUNTY My commission expires: a> Commission # §82374 Expires October §, 2024 6/1/2021 (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 3700428549 (if known) (6) Original Date of Issue 06/01/2021 (if known) (7) Reason for original issue of Warrant/Check (8): 06/11/2021 Payroll C For Services or Goods furnished 1 Other: 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