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RECEIVED NOV 2 5 2019 MARICOPA COUNTY -CLERK=BOARD,OESURERVISORS INTEROFFICE MEMORANDUM Maricopa County Schools Superintendent Office TO: CLERK OF THE BOARD FROM: Terri Ysaguirre SUBJECT: Affidavits — Replacement of Lost Warrants DATE: 11/25/2019 Please find attached 1 Affidavit/Notice of Claim(s) for lost warrants for inclusion on the next available Board agenda V 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.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. #201 Buckeye Union Zane Saunders $200.00 #201 Buckeye Union Travis Haley $212.71 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. TRAVIS HALEY (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 09/12/2019 (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 $ 212.71 .(3) Signedi: (4) (5) Subscribed and sworn to before me this '30 1-1^ day of 0 0:Voloe ,r 20 1c1 . NOTARY PUBLIC Mv commission expires: . P\ ck o (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 3700225581 (if known) (6) Original Date of Issue 09/12/2019 (if known) (7) r — gni " g% v mixi Reason for original issue of Warrant/Check (8): El Payroll LI For Services or Goods furnished REIMBURSEMENT Other: REIMBURSEMENT 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 Serving e o hwest Valley Since 19.,1 11/01/2019 Buckeye Union Iligh School 1000 E. Nail,! now Ave. Buckeye, AZ 85326 P. 623-386-4423 F: 623-386-9711 To W orn it may concern, Check 370022581 for $212.71dated 09/12/2019 was a reimbursement check payable to myself for mileage. I lost the check. I am requesting another check be reissued. Estrella 1 oothills High School 13033 S. Estrella Parkway Goodyear, AZ 85338 Thank you, P: 623-327-2470 F: 623-327-2499 Travis Ha ey E.S.S. Coordinator Exceptional Student Services 1000 E Narrarnore Ave Youngker High School Buckeye, AZ. 85326 3000 S. Apache Rd. Buckeye, AZ 85326 thaley@buhsd.org P: 623-474-0100 F: 623-474-0200 The Learning Center 751 N. 215! Ave. Buckeye, AZ 85326 P: 623-474-0332 F. 623-386-1340