STAMPED & REDACTED NATALIE HERNANDEZ.PDF

INTEROFFICE MEMORANDUM
Maricopa County Schools Superintendent Office
TO: CLERK OF THE BOARD
FROM: Terri Ysaguirre
SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 2/19/2021
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.
#33 Buckeye Elementary Natalie Hernandez $66.00
DS,
RECEIVED -2em
FEB 26 2021
MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS

Schools Affidavit/Claim Form
©O U nee
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.
Nata he Hormandez. (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 4 uly 20A0 (date)(2) a warrant/check was issued to the
Gnu
above named person/entity in fhe 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
b b Oo"
warrant/check be issued to $ (3)
Narre
A 1X Alig
signed (4)
v
(5) Subscribed and sworn to before me this_2@_? day of 20. 2/.
nent
NOTARY PUBLIC
SE, LORI D. PENNINGTON
Notary Public - State of Arizona
Na MARICOPA COUNTY
My commissign <p 5	1	31	1	2	2	1536	1843	37	31	93.229141	My
5	1	31	1	2	3	1582	1845	184	26	79.741745	Gommission
5	1	31	1	2	4	1800	1849	3	4	91.434334	Expi
4	1	31	1	3	0	717	1853	1454	93	-1	
5	1	31	1	3	1	717	1894	68	52	42.429348	2
5	1	31	1	3	2	812	1865	17	46	44.053440	[
5	1	31	1	3	3	850	1869	63	62	20.730619	S|
5	1	31	1	3	4	942	1859	56	48	23.136101	a
5	1	31	1	3	5	1073	1865	74	40	51.077850	a
5	1	31	1	3	6	1603	1877	50	31	86.362991	May
5	1	31	1	3	7	1670	1853	175	51	35.634209	18,2022
(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 3700313753
(if known) (6)
Original Date of Issue 05/14/2020 03/02/2021
(if known) (7) 7
Reason for original issue of Warrant/Check (8):
OO Payroll
O For Services or Goods furnished
Sc lapol hod Tp Lf Concival
‘0 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

PHOENIX, ARIZONA “CONTROLNO. |
FRE ae eee NTE EDS AVALAGLE (eee 1-690, AnStaGe) :
; ‘ 05/14/2020 33622804 | »z
Buckeye Elementary District #33 ™
WARRANT AMOUNT a
AY $66.00 g
*Sixty Six and 00/100“ Dollars E
VOID AFTER 365 DAYS E
Hernandez, Natalie } i
) fa
aaa -_ 2
3DER
Spanien GS07. é
= A J§ AUTHORIZED SIGNATURES —#
~~
5	1	18	2	1	2	1194	951	27	36	6.012144	iN
5	1	18	2	1	3	1752	946	27	29	75.081230	Th
2	1	19	0	0	0	60	1034	2416	39	-1	
3	1	19	1	0	0	60	1034	2416	39	-1	
4	1	19	1	1	0	60	1034	2416	39	-1	
5	1	19	1	1	1	60	1034	2416	39	95.000000	 
2	1	20	0	0	0	60	1160	2418	38	-1	
3	1	20	1	0	0	60	1160	2418	38	-1	
4	1	20	1	1	0	60	1160	2418	38	-1	
5	1	20	1	1	1	60	1160	2418	38	95.000000	 
2	1	21	0	0	0	67	1221	2306	35	-1	
3	1	21	1	0	0	67	1221	2306	35	-1	
4	1	21	1	1	0	67	1221	2306	35	-1	
5	1	21	1	1	1	67	1221	2306	35	95.000000	 
2	1	22	0	0	0	58	1272	2421	38	-1	
3	1	22	1	0	0	58	1272	2421	38	-1	
4	1	22	1	1	0	58	1272	2421	38	-1	
5	1	22	1	1	1	58	1272	2421	38	95.000000	 
2	1	23	0	0	0	463	1340	347	9	-1	
3	1	23	1	0	0	463	1340	347	9	-1	
4	1	23	1	1	0	463	1340	347	9	-1	
5	1	23	1	1	1	463	1340	347	9	95.000000	 
2	1	24	0	0	0	86	1350	1062	24	-1	
3	1	24	1	0	0	86	1350	1062	24	-1	
4	1	24	1	1	0	86	1350	1062	24	-1	
5	1	24	1	1	1	86	1350	1062	24	95.000000	 
2	1	25	0	0	0	59	1062	2328	2105	-1	
3	1	25	1	0	0	59	1062	2328	2097	-1	
4	1	25	1	1	0	1304	1062	1054	47	-1	
5	1	25	1	1	1	1304	1072	234	37	96.138527	05/14/2020
5	1	25	1	1	2	1559	1071	152	38	96.512238	Check:
5	1	25	1	1	3	1856	1066	208	37	96.461502	33622804
5	1	25	1	1	4	2197	1062	161	27	96.494110	EXPENSE
4	1	25	1	2	0	59	1109	2328	53	-1	
5	1	25	1	2	1	59	1119	193	33	52.987511	IARICOPA
5	1	25	1	2	2	268	1117	169	32	96.342613	COUNTY
5	1	25	1	2	3	453	1114	201	34	92.370651	SCHOOLS
5	1	25	1	2	4	689	1129	10	11	39.786091	-
5	1	25	1	2	5	744	1111	189	38	95.865700	PHOENIX,
5	1	25	1	2	6	951	1109	182	34	96.659912	ARIZONA
5	1	25	1	2	7	1263	1131	55	31	96.888351	AP
5	1	25	1	2	8	1332	1129	180	32	95.922531	20200513
5	1	25	1	2	9	2195	1120	192	41	95.265976	3700313753
4	1	25	1	3	0	96	1176	2208	71	-1	
5	1	25	1	3	1	96	1218	168	29	92.540977	Hernandez,
5	1	25	1	3	2	278	1216	98	28	92.540977	Natalie
5	1	25	1	3	3	973	1203	5	37	86.513306	|
5	1	25	1	3	4	1587	1195	246	39	33.993637	|_05/14/2020_|
5	1	25	1	3	5	2127	1192	5	36	76.668510	|
5	1	25	1	3	6	2297	1176	7	6	0.000000	;
4	1	25	1	4	0	390	1232	1742	55	-1	
5	1	25	1	4	1	390	1255	98	32	96.958321	Payee
5	1	25	1	4	2	974	1244	4	37	90.300224	|
5	1	25	1	4	3	1588	1238	5	37	96.174637	|
5	1	25	1	4	4	1616	1241	105	27	96.403069	Check
5	1	25	1	4	5	1731	1240	74	28	96.968575	Date
5	1	25	1	4	6	1830	1235	4	37	96.779091	|
5	1	25	1	4	7	1994	1242	7	10	91.025200	‘
5	1	25	1	4	8	2128	1232	4	37	92.616844	|
4	1	25	1	5	0	96	1310	1044	36	-1	
5	1	25	1	5	1	96	1320	142	26	96.116661	Account
5	1	25	1	5	2	250	1318	129	27	96.771629	Number
5	1	25	1	5	3	465	1317	48	26	94.393806	PO
5	1	25	1	5	4	528	1315	131	27	94.393806	Number
5	1	25	1	5	5	691	1313	117	28	96.260963	Invoice
5	1	25	1	5	6	1005	1310	135	27	96.510864	Amount
4	1	25	1	6	0	581	1369	558	23	-1	
5	1	25	1	6	1	581	1374	76	18	75.234299	201773
5	1	25	1	6	2	691	1374	76	18	3.251715	+=4307766
5	1	25	1	6	3	1080	1369	59	18	78.512054	66.00
4	1	25	1	7	0	1257	3123	1116	44	-1	
5	1	25	1	7	1	1257	3128	184	39	95.478683	VOUCHER:
5	1	25	1	7	2	1519	3130	69	26	96.179764	1145
5	1	25	1	7	3	1780	3123	124	40	96.257164	TOTAL:
5	1	25	1	7	4	2277	3123	96	29	96.853432	$66.00
2	1	26	0	0	0	99	3214	417	25	-1	
3	1	26	1	0	0	99	3214	417	25	-1	
4	1	26	1	1	0	99	3214	417	25	-1	
5	1	26	1	1	1	99	3222	102	17	92.997093	HARLAND
5	1	26	1	1	2	209	3220	83	17	91.292633	CLARKE
5	1	26	1	1	3	313	3220	74	17	92.518768	M22692
5	1	26	1	1	4	410	3214	106	21	91.634590	90325231

Attention: Accounts Payable Department
Buckeye, AZ
Hello,
To whom this may concern,
My name is Natalie Hernandez and | have a son that attended Sundance Elementary
School last year, he was in the 8th Grade. Due to Covid my son’s Sea World Field Trip
was cancelled at the end of the school year. | am writing this letter to inform you that |
did receive a refund check in the amount of $44.00 but unfortunately | cannot find the
check and | am asking if you could please void and send a new check. As your records
indicate this check has not been cashed. | would greatly appreciate it!
Thank you very much!
Natalie Hernandez