UNCLE CHUCKS STUFF.PDF

INTEROFFICE MEMORANDUM
Maricopa County Schools Superintendent Office
TO: CLERK OF THE BOARD
FROM: Terri Ysaguirre
SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 8/6/2019
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.
#401 East Valley Inst of Tech Uncle Chucks Stuff $1,475.97

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 MAR ICOPA Instruction sheet which is page 2 of this form.
uratui-nbro,5- sfik;.E (1), being first sworn, upon oath deposes and says:
On or about Nig )619 (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 $ 1 "'1 75. f 7
Signed: (4)
WIlf II
(5) Subscribed and sworn to before me this ,,Z3-70( day of ‘0,
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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
known1(6) 3 -J601941)10 1• 1-1& LOCU3
Original Date of Issue
(i( known) . (7), 6(49.00.19, APPROVED
koktia 2 019
Reason for original issue of Warrant/Check (8): DATE
E Payroll
Ile!" ZAI AP"
12/For Services or Goods furnished 501t-ok-ttr.S.' fitr-; COPA COU 417rAtr/7-
Other:
S:',PROCESSESW.tarraqts Duplicate ut Staie I02 t'otn-isSchools \SchoolsiWarrants Checks notice et clattn.dm
Revir.ed June 2315 A R.S. 11-632 1-; 15-999

Uncle Chucks Stuff
3120 Scissortail Dr.
Duncan Oklahoma 73533
Let it be known that: 4_4.2,-7,4, authorizes to handle all transactions pertaining
to any business transactions associated with the businesses known as Uncle Chucks 3D Printer Stuff / Uncle
Chucks Stuff. As a sole proprietor owned business.