STAMPED & REDACTED EXTREME PRO APPAREL.PDF

INTEROFFICE MEMORANDUM
Maricopa County Schools Superintendent Office
TO: CLERK OF THE BOARD
FROM: Terri Ysaguirre
SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 5/10/2021
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 Xtreme Pro Apparel $4,819.91

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: 5 Duplicate or | 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.
Xtreme Pro Apparel (1), being first sworn, upon oath deposes and says:
~~ Name/Claimant
On or about February 25, 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 $ 4,819.91 (3)
;
Signed; 8 4
ES
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
(5) Subscribed and sworn to before me this day of Ori \ 20 a .
;
4 W SAMANTHACVIAXINE HAFFNER
NOTARY PUBLIC NOTARY PUBLIC
STATE OF COLORADO
My co Commiceen Lubinee December
mission ones My y Commission Expires Decem 28 2024
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———-
Warrant/Check Number A88
3700402
(if known) (6)
Original Date of Issue
February 25, 2021
(if known) (7)
Reason for original issue of Warrant/Check (8):
OO Payroll
lm For Services or Goods furnished Custom clothing
O Treasurer's refund/payment
(1 Other: 05/12/2021
'
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notic
Revised April 2015

yp
To: MAY 03 2021 )
)
Agua Fria Union High School District
—————
Attn: Accounts Payable
Avondale, AZ 85323
Dear Accounts Payable,
This letter authorizes Jordon Gutierrez from Xtreme Pro Apparel dba “XPA Gear” as the
designated signer on the affidavit claim to replace a lost check. Please accept this document as
confirmation that the check no. #3700402488 has not been received. We believe it was rerouted
from our old address at : ‘ Broomfield, CO 80020 and lost in a move to the
new building located at . Fort Lupton, CO 80621. We are kindly requesting that
it is reissued today, April 28, 2021, or at your soonest convenience to settle your account’s
current invoice #2836. Please confirm it has been mailed to the new address in Fort Lupton and
remove our old address from your systems entirely.
Thank you in advance for your assistance in this matter. If you have questions, or need further
verification, please contact Jordon Gutierrez at 720-
Thank you.
Jiana Gutierrez, Director of Operations
www. .com Ft. Lupton, CO 80621