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INTEROFFICE MEMORANDUM Maricopa County Schools Superintendent Office TO: CLERK OF THE BOARD RECEIVED - FROM: Terri Ysaguirre OCT 1 4 2019 SUBJECT: Affidavits — Replacement of Lost Warrants MARICOPA COUNTY DATE: 10/11/2019 CLERK BOARD OF SUPERVISORS 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. #05 Isaac Elementary Educational Furnishings of AZ $1,703.32 g:diook Affidavit/Claim Form lication 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. +Iona being first sworn, upon oath deposes and says: Name/ On or about ir-M9 (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 $ 3D .(3) -M Signed: 1414. (4) (5) Subscribed and sworn to before me this r- ,-31-\r\ day of (-3ROsp.\.n, 20 \ NOTARY PUBLIC ELMA OFFICIAL J WESSOLLEK SEAL Notary Public - Arizona My commission expires: My MARICOPA Commission COUNTY Expires v?) w,ap"a0 JUNE 13,2020 (seal) Note: Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. Warrarquieuk iuru (if known) (6) Original Date of issue (if known) (7) Reason for original issue of Warrant/Check (8): DATE OCT15 2019 D Payroll I)ZG For Services or Goods furnished `,', A 0.A , •;: 7iE) -.1:=7\ O SUPERVISORS CC UNTY II Other: Arizona Furnishings September 30, 2019 Isaac USD 3348 W McDowell Rd Phoenix, AZ 85009 District Accounting Patricia Duarte This correspondence is in reference to warrant 37-00191373 dated 06/11/19 in the amount of 1,703.32. Ms. Duarte is processing a Schools Affidavit/Claim form for a lost payment. Melissa Williams has full signing capability in all capacities to represent Arizona Furniture. Thank you for your assistance, LivrI.) Claudia Spillman Managing Partner Arizona Furnishings