STAMPED & REDACTED EDVOLVE.PDF

INTEROFFICE MEMORANDUM \
—
‘Maricopa County Schools Superintendent Office D
RECEIVED
LG
TO: CLERK OF THE BOARD Ha i
APR 19 . 209]
AA
FROM: _ Terri Ysaguirre
MARICOPA COUNTY
LERK BOARD CF
SUBJECT: Affidavits — Replacement of Lost Warrants SUPERVISORS
DATE: 4/13/2021
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.
v The original warrant(s) have had a stop payment done.
lf 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.
#66 Roosevelt Elementary EDVOLVE $530.00

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.
EDVOLVE (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about APRIL 9TH, 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
$530.00
warrant/check be issued to him/her in the sum of ¢ <2)
{
Sign : (4)
L/
(5) Subscribed and sworn to, before me this G day of Let 207/.
Lo? C
(Mrarile YAS
i
PUBLIC CHARDAI COLLINS
. 2 Notary Public - State of Arizona
MARICOPA COUNTY
My commission expires: Commission # 576474
PH-2624— cl ay BS < Do2x| Expires January 23, 2024 (seal)
Sf (Ci 3) /
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
(| 3700367086
liftronn)
Original Date of Issue
10/22/2020
rote OI 04/21/2021
|
Reason for original issue of Warrant/Check (8):
O Payroll
C) 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

edvolve (02
Leltin Ludoy Phoenix, AZ
To whom it may concern,
| am the owner and principal for Edvolve, an LLC who has provided services for
Roosevelt School District in 2020. | am writing today in regards to Invoice
number 8202 from Edvolve. | did not receive payment and would like to request
an affidavit to reissue this payment in the amount of $530.
| may be reached via email or my cell phone at any time. Thank you
Regards,
LeeAnn Lindsey
Edvolve