STAMPED & REDACTED JOHN C. ROBINSON .PDF

INTEROFFICE MEMORANDUM
Maricopa County Schools Superintendent Office
TO: CLERK OF THE BOARD
FROM: Terri Ysaguirre
SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 2/18/2021
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 John Robinson $100.00
RECEIVED “ae
MARICOE +. COUNTY
CLERK BOARD OF SUPERVISORS
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RECEIVED
AARICOPA CONNTY FEB 23 ant 202!
CLERK BOARD OF SUPERVISORS
MARICGPA COUNTY
CLERK BOARD OF 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.
John Cc, Kobins ©WM __(1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about oy] 13/9020 (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 $_ (OQ. Oo (3)
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Signed: (4)
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(5) Subscribed and sworn to before me this _/ Fth day of Feb. 20 2-!.
NOTARY PUBLIC nsiooes
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Dec. 3B, BO2R — (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 /
(if known) (6) 37003 02A4Ti /£ 33629392
,
Original Date of Issue
(if known) (7) oO y [13 / 2020
Reason for original issue of Warrant/Check (8): 03/05/2021
OO Payroll : -
C1 For Services or Goods furnished
(2 Other: (ReCond Crreclf - Grell Xv
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

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Name —/ (Aw s0r
Address
Buckeye Elementary School District #33
Accounts Payable
Buckeye, AZ.85326
To Whom | May Concern:
After speaking with your department on Trine en it was discovered that my check for
Invoice was mailed to the incorréct address .The check was not received by me or
returned to the Buckeye elementary School District Office. | respectfully request a reissue of the
warrant.
Thank you for your help in this matter.
Sincerely,
e Yj ~~
Z
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