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RECFNEJ VOisfaZ ;AAA_ r7):7).- mr-to-ni9 INTEROFFICE MEMORANDUM MARICOPA COUNTY —CEEB - K-130ARCFOF--SUPERVISORS Maricopa County Schools Superintendent Office TO: CLERK OF THE BOARD FROM: Terri Ysaguirre SUBJECT: Affidavits — Replacement of Lost Warrants DATE: 7/3/2019 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 terrLysaguirre@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. #59 Laveen Elementary Maria Arellano $2,307.79 Application for a Duplicate or Stale-Dated ivAllarrantleft eck Affidavit/Claim Form This application is for: IN Duplicate or D Stale-Dated (definitions are on page 2) STATE OF ARIZONA I Note: Numbers on this form correspond to numbers on the COUNTY OF MARICOPA Instruction sheet which is page 2 of this form. Maria AreIlan° (1), being first sworn, upon oath deposes and says: 7Nrame/Claimaffi. On or about June 4, 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 alter 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 s 2 ,307 .79 .(3 ) Signed: (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) Subscribed and sworn to before me this __243___day of 2 nqvci 2 NOTARY PUBLIC My commission expires: if) 03) 4-u critackirt al) Warrant/Check Number 3700186844 (if known) (6) Original Date of issue 06/04/2019 _ (if known) (7) JUL hi 2019 Reason for original issue of Warrant/Check (8): III Payroll 0 For Services or Goods furnished Treasurer's refund/payment 0 Other: SAPROCESSES\WarraMs - Oupiicale or Stale= Forms\Warrants thecits notice ol claim - topy.doc Revised April 2015 A.R.S. 11-632 & 11-644 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of Sari 01--ecp Subscribed and sworn to (or affirmed) before me on this day of IV, , 20 c', by i—t_CtY-iLi J 79- 1-,21(Ctic7( proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. • dmimmumummosimmunk t. ERIKA L. OARC1A geu r4t COMM. #2170406 NOTARY PM!) •CAUFORNA • W NiirX 4, MN DIEGO COUNTY (ilea C°""1"" 6'0" 1102e2620 %mature iimetiammeilimmitmellimr-