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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: 8/23/2019 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. #79 Litchfield Elementary Marjon Ceramics Inc $414.01 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. Marjon Ceramics, Inc (1), being first sworn, upon oath deposes and sa ys: Name/Claimant On or about 05/07/19 (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, 2r, 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 ewing, and the applicant requests that a replacement warran eck be issued to him/her the u of $ 414.01 .(3) 11,J id , rubscribed and sworn to befo NOTARY PUBLIC Myl /NJ" SHANNAN VICKERY (seal) My Comm. Expires Apr 16, 2021 Noterna. 177Pgrairnairryw,* the warrant/check if available and/or any other evidence that a warrant/check was originally issued. Warrant/Check Number 3700175596/79727746 (if known) (6) Original Date of Issue 05/07/2019 (if known) (7) Reason for original issue of Warrant/Check (8): 0 Payroll For Services or Goods furnished Fine Arts Supplies 0 Other: Fine Arts Supplies S:\PROCESSES\Warrants - Duplicate or Stale \02 Forms\Sc.hools\Schools-Warrants Checks notiCe of daim.doc Revised June 2015 • A.R.S. 11-632 81.15-999 Marjon Ceramics, Inc. 3434 W. Ear11 Dr., Suite 101 Phoenix, Az. 85017-5289 Ph: 602-272-6585 Fax: 602-272-1507 www.marjonceramics.com To whom it may concern, I am Shannan Vickery the manager of Marjon Ceramics Inc. I am an authorized Notary for our company, Jayne Michael has signed the affidavit and is an authirized buyer/clerk for our company. Any other inforamtion please feel free to call me. My number is listed before. Thank you, Shannan Vickery The letter and affidavit is in another email being sent on 8/14/19 Shannan Vickery Marjon Ceramics Inc. 3434 W.Ear11 Drive Ste. 101 Phoenix, Az. 85017-5284 602-272-6585 fax 602-272-1507 www.marionceramics.com