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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: 9/25/2019 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. #17 Tolleson Elementary Hannah Wilt $170.16 RECEIVE SEP 27 2019 MARICOPA 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. niwk ) (1), being first sworn, upon oath deposes and says: Name/Claimant On or about LUAJ1cSf 8, 2-Ofct (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 $ /170 . .(3) Signed: (4) (5) Subscribed and sworn to before me this 9-12 day of Sepi-Pn4er 20 /9' . NOTARY PUBLIC 111I4111111 6"d6116. 1".111414 nEL TORO My commission expires: - Arizona e_\0.1-11 cl pan 1 1.saY‹ opa County (seal) , tores Feb 27, 2020 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) 3r-loo 2 1 UO2.2_ Original (if Date known) of (7) Issue 8 . 3 . 2-orq , SEP 3 0 2019 Reason for original issue of Warrant/Check (8): CI Payroll El For Services or Goods furnished X Other: e,finhalfseme_nAL SAPROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim,doc Revised June 2015 A.R.S. 11-632 81. 15-999 'Scri-eAinLoAr /q4/ 20 (q Hannah Wilt To Whom It May Concern This letter is intended to notify the appropriate parties that I, Hannah Wilt, did not receive the reimbursement check mailed to my home address on August 15, 2019. The check was never delivered and was lost in the mail. Thank you Sincerely, Hannah Wilt