STAMPED & REDACTED MOTOROLA SOLUTIONS INC.PDF

INTEROFFICE MEMORANDUM
Maricopa County Schools Superintendent Office
eeewen ar
RECEIED
TO: CLERK OF THE BOARD DAT Ne™
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FROM: _ Terri Ysaguirre MAR O14 2021
SUBJECT: Affidavits — Replacement of Lost Warrants MARICCPA COUNTY
CLERK BOARD OF SUPERVISORS
DATE: 2/26/2021
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.
If you have any questions, please contact Terri Ysaguirre at 602-372-1245 or via e-mail at
terri.vsaguirre@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.
#95 Queen Creek Unified Motorola Solutions. Inc $2,073.27

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.
MOTOTOLA SOLUTIONS, INC __(1), being first sworn, upon oath deposes and says:
~Name/Claimant
97/28/2020
On or about (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 ¢2073.27 (3)
Signed: LY aK oh (4)
a
(5) and sworn to before me this 2. 7”\ day of. 202 .
Poa
ane
Waal Arenbac
NOTARY PUBLIC
SARAH RIEDER
Notary Public
My commission expires: Commission Number 595804
AS, 2025 wag tll aiag (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
37003401 79
‘__(if known) (6) 03/03/2021
Original ginal Date of Issue = -
of 197/28/2020
Date Issue
Reason for original issue of Warrant/Check (8):
1 Payroll
lm For Services or Goods furnishedAIRTIME CHARGES
O Other: AIRTIME CHARGES
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

© MOTOROLA SOLUTIONS
Corporate Address: Chicago IL 60661
Local Address: Phoenix AZ 85040
2/25/2021
Queen Creek Unified School District #95
Queen Creek, AZ 85142
Dear Queen Creek USD #95,
The affidavit form has been notarized and signed. This letter is to confirm that Jessica Savage,
Airtime Coordinator, has the authority to sign the affidavit.
Sincerely,
Jim Bloomfield
Service Support Manager
/ yj
( Email: Jim.)
~602-.
Motorola Solutions, Inc.
Phoenix, AZ 85040