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INTEROFFICE MEMORANDUM
Maricopa County Schools Superintendent Office
RECEIVED
TO: CLERK OF THE BOARD JUN 2 8 2019
FROM: Terri Ysaguirre MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS
SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 6/27/2019
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.ysaguirre@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.
#60 Higley Unified Tera Geyer $1,195.49
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.
Tera Geyer (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 6/7/2J0/8 (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/c*k be issued to pim/her in the sum of $ I, I 5. Y9 .(3)
Signed: (4)
N3
pbscribed and sworn to before me this .3 V day of •Ji.-{4/6" 20 / 9 .
BLIC
OFFICIAL SEAL
My • • ilen4 St ate of TO Arizona ;
MARICOPA COUNTY (seal)
't•isin.,!-' Gomm • "O. • • rat #556063 • • MEM • • moml Exp. • • Noma Nov. • • wa., 5, • • Imp 2022 cr•CI. !
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 3700043656/60558663
(if known) (6)
Original Date of Issue 06/07/2018
(if known) (7)
Reason for original issue of Warrant/Check (8):
Payroll
O For Services or Goods furnished
O 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
June 24, 2019
To Whom It May Concern,
I am writing this letter to explain the circumstances behind my request for asking Higley Unified School
District to reissue check # 3700043656. The Check was initially issued to me on June 7 th 2018 as part of
my summer installment checks from the 2017-2018 calendar school year. (Certified Teacher) I had put
this particular check away to use for a family trip that was going to occur in December of 2018. Prior to
the trip, we had done some remodeling in our home and had packed up our office area where I had
stored the check. The check was misplaced during the packing and when I was cleaning out some
documents during June 2019, I found the misplaced check.
I found the check on Friday June 7, 2019 so I took it to the bank hoping that they would be able to
deposit it. The bank initially took the check and said it was still valid. I received notice several days later
that the bank was unable to process the check due to the stale date. (Please see attached copy of
check)
If you have any questions or need further information, please contact me at 480.227.4753.