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INTEROFFICE MEMORANDUM Maricopa County Schools Superintendent Office ; RECEIVED TO: CLERK OF THE BOARD ym JUN UN 28 202 02) FROM: Terri Ysaguirre MARICOPA COUNTY SUBJECT: Affidavits a — Replacement of Lost Warrants CLERK BOARD OF SUPERVISORS DATE: 6/25/2021 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 Steven Berg $4,146.10 #60 Higley Unified Steven Berg $3,281.34 RLC ie ue <— Schools Affidavit/Claim Form ae 85 ‘ 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. Hieven Sent (1), being first sworn, upon oath deposes and says: On or about 6/15/21 (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 3281.34 warrant/check be issued to him/her in the sum of $ (3) Wz A. Ux Signed: (4) (5) and sworn to before me this AT Ayn —_ day of Sune 20 PA. Ova una Nive NOTARY PUBLIC PAULA WOLTER 2, = Notary Public - Arizona My commission expires: | MARICOPA COUNTY Commission # 592374 \O/ae) 24) Expires October 5, 2024 (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 \o ean 323434 370 0434414 (if known) (6) Original Date of Issue | ; (if known) (7) i, ey ) 22\ Reason for original issue of Warrant/Check (8): Payroll O For Services or Goods furnished 06/29/2021 C1 Other: ' S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Revised June 2015 A.R.S. 11-632 & 15-999 Schools Affidavit/Claim Form i tN ene Conn 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. Steven Berg (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 6/15/21 (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 4146.10 warrant/check be issued to him/her in the sum of ¢ (3) BE A foo Signed: (4) and sworn to before me this 2 ui day of av NE 202). Drala, Woden Wa. Volar” oo NOTARY PAULA WOLTER 2 Notary Public - Arizona iz} MARICOPA COUNTY My commission expires: Commission # §92374 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 = (if known) (6) 37) O OW 3 al 3 a, ) Original Date of Issue soy ’ (if known) (7) GJ) 224 Reason for original issue of Warrant/Check (8): Payroll 06/29/2021 O For Services or Goods furnished O 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