STAMPED & REDACTED FRYS CUSTOMER CHARGES.PDF

INTEROFFICE MEMORANDUM
Maricopa County Schools Superintendent Office
TO: CLERK OF THE BOARD
.
FROM: Terri Ysaguirre
SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 3/24/2021
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. a
#66 Roosevelt Elementary | Kroger — Frys Customer Charges $308.70
I
RECEIVED 20nd
MAR 25 2021
MARICOPA COUNTY
CLERK BOARS Cr
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
COUNTY OF MARICOPA instruction sheet which is page 2 of this form.
Cuchrnte Chavoyts: (1), being first sworn, upon oath deposes and says:
ee sant
On or about 2/2b ZO2Z/ (date)(2) a warrant/check was issued to the
above named personfentity 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
Bayz 7O
warrant/check be issued to him/her in the sum of $ (3)
Signed: dea (4)
(5) Subscribed and sworn to before me this_2 nc|_day of Warclh 20.21.
AMY ORRISON
5
NOTARY PUBLIC
My commission expires: STATE OF KANSA
==) eevesy
B - 1-24 My Appt. Exp. (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
BVO FIL b 2
(if known) (6)
Original 9 Date of Issue 13/202)
/
(if known) (7)
4
Check
Reason for original issue of wardati (8):
O Payroll
. 03/26/2021
Services or Goods furnished . -
(1 Other:
REGEIVEB
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc
2 A.R.S. 11-632 & 15-999
Revised June 2015
MAR j i 4 94
)
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Business Services

Kroger Accounting Services-Hutchinson
Hutchinson, KS 67504-1648
To Whom this may concern:
This is a letter of notification that check submitted for payment of 308,70 check number 3700390102
dated 01/13/2024 control #66908611, this is for payment on account for Roosevelt #66 for the address
- , Phoenix, AZ 85002, was never received to Kroger Accounting.
Please respond should you have any questions.
Thank you,
Barb Klug
Kroger Accounting Services
PO Box
Hutchinson KS 67504-1648 a