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INTEROFFICE MEMORANDUM Maricopa County Schools Superintendent Office TO: CLERK OF THE BOARD FROM: Terri Ysaguirre SUBJECT: Affidavits — Replacement of Lost Warrants DATE: 11/4/2019 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. 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. #402 West-MEC Silvia Lopez $150.00 (Stale) BECENE.D 1'10\1 05 2019 COUNTY NIP,BIGOON 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 f_COUNTY OF MARICOPA Instruction sheet which Is page 2 of this form. I (1), being first sworn, upon oath deposes and says: Name/Claimant On or about-SO/NZ, g co a O. (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, at 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/che sued to him/her in the sum of $ 1 5171) .(3) Signed: APAriiiiiiifillIFA 114././ I••I (4) (5) Subscri ed and sworn to before me this 1 fn day of 00rObt'i r 20 19. ita • 70, NOTARY PUBLIC ADRIANNA AMEZCUA My commission expires: NOTARY Maricopa PUBLIC County - ARIZONA 05/1q/,9-190D My Commission Commission # 548004 Expires May 19, 202g 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 '7 --1 nco 5 1-1 (If known) (6) ID 1" Original Date Date of Issue Of known) (7) 0 L.0 — Reason for original issue of Warrant/Check (8): El Payroll ID For Services or Goods furnished 1270ther: SkUcile-ciry-t . U SAPROCESSES\Warrants - Duplicate or Sta142 Forms\Schools\Schools-Warranta , Checks notice of cialm.doc A.R.S. 11-632 & 15-999 Revised June 2015 OCT 2 8 2019 -