STAMPED & REDACTED AERO EQUIPMENT RENTAL & SALES.PDF

INTEROFFICE MEMORANDUM
TO: CLERK OF THE BOARD
FROM: Terri Ysaguirre
SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 4/14/2021
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.
#05 Isaac Elementary Aero Equipment Rental & Sale $566.82

Schools Affidavit/Claim Form
Application for a Duplicate Warrant/Checl« (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
Deve Coyspnent Lo, ital (1), being first sworn, upon oath deposes and says:
J
ovaneeate Qn e€ pny
On or about _ “4 JS&~-20 (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, Of 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 in the sum of sh 2.69 (3)
46)
O.
signed Le Y) “4 LN (4)
// cs : co NS
(5) Subscribed and sworn to before me this (0 day of Ayes | 202 :
(ayn babel hacer’
NOTARY PUBLIC
commission expires:
S
Zo, 2022
i
iN
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrani/check was originally issued.
.
Warrant/Check Number = - . |
37-00284540
(if known) (6)
|
Original Date of Issue -
(if known) (7) S -15- oO
Reason for original issue of Warrant/Check (8):
04/16/2021
(1 Payroll
Z For Services or Goods furnished
() 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

N. 35th Ave. Phoenix, AZ 85017
(602) www. .com
RENTAL & SALES
April 7, 2021
Isaac School District #5
Phoenix, AZ 85009
To Whom It May Concern:
Listed below are the designated signers for our company.
Jason Palmer, President
Nicole Palmer, Vice President
Regards,
Jason Palmer