STAMPED & REDACTED ARIZONA K12 CENTER FOR PD.PDF

INTEROFFICE MEMORANDUM
Maricopa County Schools Superintendent Office
)
sgt
(
RECEIVED
oy,
TO: CLERK OF THE BOARD JUN 9.8 2021 Mo
FROM: Terri Ysaguirre MARICOPA Re COUNTY
CLERK BOARD OF SUPERVISORS
SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 6/23/2021
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.
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.
#17 Buckeye Elementary Arizona K12 Center for PD $118.00

Schools Affidavit/Claim Form
Application fora 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.
MtizonaKi2Cewrer (1), being first sworn, upon oath deposes and says:
On or about (date)(2) a warrant/check was issued to the
a Nah ti 2 2001
above named person/entity irf 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, claimznt 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%.00 (3)
abu ombacoli
Signed (4)
(S) Subscribed and sworn to before this GA ray of Csr 20 .
me
TARY PUBLIC . SOPHIA SANDOVAL
EM,
S (sy Notary Public - Arizona bp
©
My commission expires: q arenps Coury
BHoile0ge s Comm, Exoires Feb 1, 2022
oar (seal)
t
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 oS) 7 OO 3 5 0 £ CA
oranaipaeass® | 09 [03 Avge
Reason for original issue of Warrant/Check /3):
O Payroll
“ ont fa a fio
W For Services or Goods furnished ELENA [S n
—
O Other:
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Ch
Revised June 2015
06/29/2021

OO)
ARIZONA
Ki2 CENTER
June 21, 2021
To Whom It May Concern:
As the Executive Director of the Arizona K12 Center, please let this letter
serve as my approval and authorization for Valerie Lombardi, the Arizona K12
Center's Fiscal Oversight Manager, to act on our behalf and sign the
appropriate paperwork as we seek a check replacement from Buckeye
Elementary School District
Sincerely,
Kathleen Wiebke
Executive Director
NORTHERN
@: ARIZONA
UNIVERSITY

7] My ARIZONA : 94-2/1221 = ay Ba
DATE CONTROL NO.
PHOENDG
FROM DATE MARKED “INSUFFICIENT FUNDS" an
INTEREST STOPS ON DATE FUNDS AVAILABLE. (SEC 11-636, ARS1956)
09/03/2020 33623557
Details
Buckeye Elementary District #33
WARRANT AMOUNT ED
PAY
$118.00
“*One Hundred Eighteen and 00/100*™* Dollars Included.
VOID AFTER 365 DAYS
TO Arizona K12 Center for PD \ Features
_ — ~
THE Attn: Josie Arredondo
otha y
ORDER
_ Superinisndent steve Wat ot F Securit
OF ye i if
er RIZED SIGNATURES
| oo —__ |
or
Th weoogs iB Th
09/03/2020 Check: : 33623557 EXPENSE
| MARICOPA COUNTY SCHOOLS + PHOENIX, ARIZONA
3700350852
|
Arizona K12 Center for PD | |__09/03/2020_| |
| | Check Date | ; |
Payee
Account Number PO Number Invoice Amount
210522 0831522 118.00
VOUCHER: 1030 TOTAL: $118,00
HARLAND CLARKE 22692 90325231