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INTEROFFICE MEMORANDUM Maricopa County Schools Superintendent Office RECEIVED TO: CLERK OF THE BOARD FROM: Terri Ysaguirre JUN 25 2019 SUBJECT: Affidavits — Replacement of Lost Warrants CLERK MARICOPA COUNTY BOARD OF SUPERVISORS DATE: 6/24/2019 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@mcesa.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. #33 Buckeye Elementary Theresa Marsical $656.94 #44 Avondale Elementary Arrowhead Superior Refrigeration $4,822.41 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. L/F44/4'W ": 50-vollt ), being first sworn, upon oath deposes and says: Name/Claimant On or about Ot - 6 - L°I (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,pe issued to him/her in the sum of $ I .(3) Signed: P (4) (5) Subscribed and sworn to before me this day of J' 20 1 61. Ok,LNAL C NOTARY PUBLIC Monica Calvin Commission #559949 My_ commission expires: Notary Public - Arizona — P b. My Maricopa Commission County Expires (seal) February 4, 2023 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 / '1 l_p I 11 Lo tio (if known) (6) Original Date of Issue (if known) (7) Reason for original issue of Warrant/Check (8): 0 Payroll IV For Services or Goods furnished ,2-v•ti6--0-- QA-t [L. - 11(.2-I ku_20-1 LI 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 ARROWHEAD SUPERIOR REFRIGERATION SERVICE, LLC ALMA GRIEGO OFFICE MANUEL GRIEGO ARROWHEADSUPERIOR@GMAIL.COM 8961 N 79TH AVE MANGRIEGO@COX.NET 602-510-6613 SUITE #102 602-368-5191 PEORIA, AZ 85345 LICENSED * INSURED * BONDED * ROC ASR #304718 To whom it may concern; I Manuel Griego give Alma Griego authorization to sign on all matters legal or otherwise pertaining to Arrowhead Superior Refrigeration Service, LLC. Please feel free to contact me if you have any questions or concerns. Thank you, x Manuel Gr qo 06/14/2019 Owner 602-696-8269