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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: 7/31/2019 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. #216 Agua Fria Union K 0 Oliver LLC $500.00 #79 Litchfield Elementary Wildology AZ LLC $360.00 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: g Duplicate or 0 Stale-Dated (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. K 0 Olivier LLC (1), being first sworn, upon oath deposes and says: Name/Claimant On or about May 23, 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 is7 d to hi /hein the sum of $ 500.00 .(3) A Signed: 4 (4) Note: Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. (5) 6CI S scribed and n to before me this 1 1/ *it- day of ..) LA.I q 20 ll . DEENA EMOND N Y PUBLI beend_ Ehi STATE NOTARY OF NEVADA PUBLIC APPT. NO. 94-4779-1 MY APPT. EXPIRES APRIL 19, 2022 My commission expires: <1. ii • 4v aa_ (seal) Warrant/Check Number 3700185645 (if known) (6) Original Date of Issue May 23, 2019 (if known) (7) Reason for original issue of Warrant/Check (8): AUG 0 5 2019 LI Payroll ID For Services or Goods furnished Ad( LI Treasurer's refund/payment El Other: Registration for Summer Camp S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc Revised April 2015 A.R.S. 11-632 & 11-644 LADY REBEL BASKETBALL SUMMER CAMPS 4505 S. Maryland Parkway • Box 450016 Las Vegas, Nevada 89154-0016 Phone (702) 895-3151 Fax (702) 895-1269 Agua Fria Union High School District, We have not received the payment for our Summer Camp from Millennium High School. The signer of the affidavit/claim form, Katherine Olivier, is the owner of the K.O. Olivier LLC. Please mail a check made out to K.O. Olivier LLC for $500 to Lady Rebel Basketball Summer Camps ATTN: Katherine Olivier 4505 S. Maryland Pkwy. Box 450016 Las Vegas, NV 89154 If you have any further questions, please contact me at 702.895.3041 (office) or 702.249.8493 (cell). Representative of the business/organization