2-TRUCK PRO AND EBERHART LUNA.PDF

INTEROFFICE MEMORANDUM
Maricopa County Schools Superintendent Office
TO: CLERK OF THE BOARD
FROM: Terri Ysaguirre
SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 9/10/2019
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.
#95 Queen Creek Unified --VkZ Brake & Clutch $534.51
#17 Tolleson Elementary I Marie Ann Eberhart Luna $163.09
Prock554,c(a6
RECEIVED
SEP 11 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.
Tr.cf-erb / c— (1), being first sworn, upon oath deposes and says:
NamerGia mant
On or about 1 3 1— Id/ (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 subse quently inadvertently lost or destroyed and there is
no reasonable probability of its being found or presented for pa yment, or it was not
presented for pa yment 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 owin g, and the applicant requests that a replacement
warrant/c ck be issu 4n/her in the sum of $ 3 41 51 -(3)
Signed: (4)
-
(5) Subscribed and swor to before me this ,...--741—day of ,Zzlig„,t20 751
AO
N fiTARY PUBLIC t e-Aptp ***
My commission expires:
ifTE. ST NANTEEZE:\I tea!)
: NOTARY I
%. PUBLIC .•
Note: Please attach a copy of the warranC/4 iNeal lable orAkother
evidence that a warrant/check was originally iss ty,st: ******* • • 41,,v
Warrant/Check Number 79 --) 3/0 3 w/o_ -....mtn•-_,, atN w-
(if known) (6) j `WON ExpOkt-'
Original Date of Issue
(if known) (7) 1 — 31-11
Reason for ori ginal issue of Warrant/Check (8):
El Payroll
For Services or Goods furnished Vi-e-at v.3 c L-4'.3 erfs
0 Other:
SAPROCMWarrants - Duplicate cr. 5thle \ 02 Forme%Sotx-$5\5dcols-Wanants Owas noSce of daim.doc
Revised June 2015 A.R.S. 11-532 & 15-999
CLERK, BOARD OF SUPERVISORS
MARICOPA COUNTY
— -

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.
Olivk Ary\ Eitcwkov- t,,t.,-LQ (1), being first sworn, upon oath deposes and says:
Name C anneal'
On or about ct.,m Gcs-t- 15 (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/(ch ck be. issued to him/her in the sum of $ 1(03 o9 .(3)
Signed: (4)
(5) Subscribed and sworn to before me this -r--1 day of Se_pferviber 20 /9 .
kk 40\A IL
OTARY PUBLIC
My commission expires: e0 •-‘- 141,1 l'''!' ISABEL DEL TORO
Notary Public - Arizona
01_01/) Maricopa County (seal)
j My Comm. Expires 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) 3 -7 002-/S2S-863
Original Date of Issue
(if known) (7) A SEN 2 2019
Reason for original issue of Warrant/Check (8):
CI Payroll ERK, MARICOPA BOARD OF COUNTY SUPERVISORS
0 For Services or Goods furnished
X Other: ern 10)0,9.e-e Re cryilobtxs.e.-vien---(---
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