STAMPED & REDCATED DISCOUNT SCHOOL SUPPLY.PDF

INTEROFFICE MEMORANDUM
Maricopa County Schools Superintendent Office
TO: CLERK OF THE BOARD
FROM: Terri Ysaguirre
SUBJECT: Affidavits — Replacement of Lost Warrants
|
DATE: 5/7/2021
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.
#79 Litchfield Elementary Discount School Supply $77.49
RECEIVED -12%
MAY 10 2024
CLERK a o mone UN
BOARD cp
SUPERVISORS

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
DISCOUNT SCHOOL SUPPLY (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 02/04/2021 (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 $ 717.49 (3)
}
p | ZL (4)
Signed: If
KE
(5) Subscribed and sworn to before me this day of 20.21
NOTARY PUBLIC See Aittachec
For Notary
_ .
My commission expires:
(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 | 3700396623/79739461
(if known) (6)
Original Date of Issue 02/04/2021
(if known) (7)
Reason for original issue of Warrant/Check (8):
OF Payroll
f@ For Services or Goods furnished 05/10/2021
-
O Other:
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc
ARS. 11-632 & 15-999
Revised June 2015

CALIFORNIA JURAT
A notary public or other officer completing this certificate verifies only the identity of the individual who signed
the document, to which this certificate is attached, and not the truthfulness, accuracy, or validity of that
document.
STATE OF CALIFORNIA }
Y OT 2VeY
COUNTY OF }
,
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Subscribed and sworn to (or affirmed) before me on this day of ;
Date Month Year
“Peaadvie H\ agallen
by
Name of Signers
proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me.
' oi OSCAR CERVANTES |
Notary Public - California
¢ Monterey County 3
Signature: Commission # 2237167
Signature of Notary Public My Comm. Expires Apr 7, 2022
Seal
Place Notary Seal Above
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or fraudulent
attachment of this form to an unintended document.
Description of Attached Docu ment
Fopli cation ov Chock
Title or Type of Document: Duplicate
Document Date: Si ops! 4-(3- 202 |
—
Number of Pages:
Signer(s) Other Than Named Above:

24
“DISCOUNT
SCHOOL SUPPLY
Monterey, CA 93940
April 23, 2021
Litchfield Elementary School District #79
Attn: Beverly Marstall
Litchfield Park, AZ 85340.
Dear Ms. Marstall,
Please be advised that Beatriz Magallon is authorized to sign the attached
affidavit on behalf of Discount School Supply.
If you have any further questions, please contact me direct at 831-333-
Sincerely,
Dutlldue
—
ichelle Leeman
Senior Accounts Receivable Manager

MARICOPA COUNTY SCHOOL SUPERINTENDENT
4041 N Central, Suite 1100
PHOENIX, AZ 85012
TO: PAYROLL — ACCOUNTS PAYABLE
PLEASE STOP PAYMENT AND REISSUE THE FOLLOWING WARRANT:
OTA,
DISTRICT NUMBER:
PERSON REQUESTING Bevec Marsa \ PHONE it: EXT:
STOP PAYMENT: Lu
27 O° 27@¢23 WARRANT DATE: OF 764 J Zor \
WARRANT NUMBER: -_
(prefix) (number) (mm) (dd) (yy)
count Scoot SUPPLY
PAYABLE TO: Ds
AMOUNT: 77-44
VOUCHER NO:_ S48 >
FUND NO: __
CHECK ONE: EXPENSE PAYROLL
|
ve
REASON FOR STOP: . \ CESSuke ;
Crhrec® Was lasae in Mac Drease
5
(LOST, DESTROYED, ETC.)
ONE ORIGINAL AFFIDAVIT AND ONE COPY OF THE APFIDANIT ARE ATTACHED. PLEASE
ISSUE A REPLACEMENT WARRANT.
(FOR COUNTY USE ONLY) ©
STATUS VERIFIED:
REPLACED:
STOP DATE: ,
| “WARRANT #:
STOP VERIFIED:
AFFIDAVIT SENT:
AFFIDAVIT APPROVED:
RECONS RETURNED: STOP PREPAID
Revised 4/5/07
Desk (finance) sample memos, etc\LOST WARRANT STOP-REISSUE COVER SHEET.doc
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