STAMPED & REDACTED JOHNATHAN BAILEY.PDF

INTEROFFICE MEMORANDUM
Maricopa County Schools Superintendent Office
TO: CLERK OF THE BOARD
FROM: Terri Ysaguirre
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SUBJECT: Affidavits —- Replacement of Lost Warrants
DATE: 2/17/2021
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.vsaguirre@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.
#90 Saddle Mountain Unified Jonathan Bailey $188.46
APR 28 2024
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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.
Jonathan Bailey (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about j=2-4- 202\ (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
188.46
warrant/check be issued to him/her in the sum of $ (3)
Signed: Dan Petey (4)
(5) Subscribed and sworn to before me this _\L£ ia" day of reélbr Won 2021.
jane fp.pwole
NOTARY PUBLIC NANCY P PIEDRA
C=
Ca Notary Public - Arizona
3 Maricopa County
My commission Wy Commission # 589419
ries Ze, 2 L024 My Comm. Expires Sep 26, 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 Numb Number
ant/Check 13700385709
Original gna Date of I
a (12/29/2020 04/26/2021
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Reason for original issue of Warrant/Check (8):
@ Payroll
L
C1 For Services or Goods furnished
1 Other: L
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

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«
tye f A owarrants ah Gi Linc: = i et ues fite ea 3700385709 STAMBBS TGS Warrant number
iW) Agency * Status Warrantnumber |ssued date Paid cate Amount
5050 Stopped 3FO0385 709 12/28/2020 12:00:00 am 182.45
Warrant number: 370032570
Amount Payee Account