STALE BIGBY.PDF

INTEROFFICE MEMORANDUM
Maricopa County Schools Superintendent Office
TO: CLERK OF THE BOARD
FROM: Terri Ysaguirre
SUBJECT: Affidavits — Replacement of Stale Warrant
DATE: 7/18/2019
Please find attached 1 Affidavit/Notice of Claim(s) for lost warrants for inclusion
available Board agenda on the next
V The attached item(s) have been researched to ensure that the warrant(s)
not been cashed or previously re-issued. in question have
V The original warrant(s) have had a stop payment done.
If you have any questions, please contact Terri Ysaguirre at
terrLysaguirre@maricopa.gov . Approved 602-372-1245 or via e-mail at
of School Finance Division at 4041 Affidavits may be routed back to the Superintendent
N. Central Avenue #1200, (12th Floor) Thank you.
#33 Buckeye Elementary Paul Rodriguez-Bigby
$4,869.36

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.
Paul Rodriguez-Bigby (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 6/7/2018 (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 $4,869.36 .(3)
Signed: (12 cf so-e, ?‘ (4)
(5) Subscxibed and sworn to before me this day of itkilLe. 20a.
046
NOTARY PUBLIC
ELSA GARCIA
Notary Public - Arizona
ommi4on expires: Maricopa County
1 (Cr) I ) td-000 My Comm Expires Mar 1, 2020 (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 3700041767
(if known) (6)
Original Date of Issue 6/7/2018
(if known) (7)
Reason for original issue of Warrant/Check (8):
Payroll
0 For Services or Goods furnished
0 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

Edit Check
Bank Information
Bank Account: Maricopa County Treasurer 987654321 Statue: Printed
Check Information Account Detail II Pay Check Detail Additional Check Info
Buckeye Elementary School District #33
Pay To RODRIGUEZ-BIGBY, PAUL Check 14: 336 5819
The Order 25768 WEST MAGNOLIA Date: 06/07/2018
Of:
BUCKEYE, AZ 85326 Amount: $4869.3E
Four Thousand Eight Hundred Sixty Nine and 36/100 Doll-firs
11141 Mode: Edit Record 1 of 1
=1) I Cancel Help

ci.12 {Nt) 4-
-40"o cI,
3 I)t- 5LA‘, (0 c=1,04 Co 2D V(4.
Ct&Jc-,e_ILl LA)10,-2? r\S kl? -7),N
7
1 9
2 2