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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: 8/13/2019 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.vsaguirre@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. #60 Higley Unified Flocabulary $672.00 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. Flocabulary (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 05/28/2019 (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 $ 672.00 .(3) Signed: (5) Subscribed and sworn to before me this 8 day of ax4 20 i Ci . NOTARY PUBLIC t. 1 rn I 14 MY COMMISSION NATAL1 BARSKI 1FF 940212 EXPIRES: December 1,2019 My commission expires: ,Z14' Bonded Thru Notary Pubic Undenerlire 12-11 lig (seal) 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 3700186027 AUG 1 5 2 19 (if known) (6) Original Date of Issue 05/28/2019 (if known) (7) _.414/1-A --1VIAFI';C;;; Reason for original issue of Warrant/Check (8): O Payroll • For Services or Goods furnished Online Access for teacher Software • Other: 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 nearpod 'ocabulary BY nearpod August 8, 2019 VIA FEDEX Higley Unified School District Attn: Lisa Bate 2935 S Recker Rd Gilbert, AZ 85295 RE: Lost Check for Invoice Number 55599 To Whom it May Concern: This letter is meant to provide notice that Severine Vieux, the VP of Finance for Flocabulary, Inc. is an authorized signatory with the authorization to sign the Schools Affidavit/Claim Form for the lost check related to the above-referenced invoice number. Should you have any questions, please do not hesitate to contact me. Sincerely, z0'7/ Maurice Heiblum, President & COO Phone 1-855-NEARPOD (632-7763) Fax 305-655-1999 I 1855 Griffin Rd., A290, Dania Beach, FL 33004 www.nearpod.com