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INTEROFFICE MEMORANDUM Maricopa County Schools Superintendent Office TO: CLERK OF THE BOARD RECEIVED cyviov' FROM: Terri Ysaguirre JUN 04 2019 Ylqw SUBJECT: Affidavits — Replacement of Lost Warrants MARICOPA COUNTY DATE: 5/31/2019 CLERK BOARD OF SUPERVISORS 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. #216 Agua Fria Union Daphne Faber $100.00 #5 Isaac Elementary Standard Restaurant Equipment $3,323.16 Schools Affidavit/Claim Form Application for a Duplicate litiarrant/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. -e (2)/v ( (1) ibeing first sworn, upon oath deposes and says . C4 ( 'Ma qv-Du skIncLAtord Ke-ickuma • Et11- 14 went co On or a3out (clate)(2) a warrant/check was issued to the above named person/entity n 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/che9K)be issued to him/l)er in the sum of $ 01 Oa 3, / (3 ) Signed: (4) (5) Subscribed and sworn to before me this /7 day of Mar 20/5' . A 4,91, NOTARY PUBLIC Notary Pubilo RACHEL. PORTER I My commission expires: kle Campiesion Correrieice #691321 Expires I • =n 15, 2020 I (seal) I. ett IMP NM Utah MOM NM Wi 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 2,/--7 nn 1 / _, / (if known) (6) c-7. / - Uti 1 -lf1 1-1 Original Date of Issue (if known) (7) Lii q / -01 fq Reason for original issue of Warrant/Check (8): JUN.0 4 2019 O Payroll For Services or Goods furnished Other: SAPROCESSES\Warrants - Duplicate cr Stafe\02 Forms\Schools\Schcols-Warrants Checks nofte of Caintdoc Revised June 2015 A.R.S. 11-532 a 15-999 STANDARD 1 RESTAURANT EQUIP. CO . ARIZONA ARIZONA I NEVADA NEW MEXICO UTAH 2922 East McDowell Rd 601 South Cherry Avenue 5675 South Valley View 2405 Candlaria 3500 South West Temple Phoenix, Arizona 85008 Tucson, Arizona 85719 Las Vegas, Nevada 89118 Albuquerque, New Mexico Salt Lake City, Utah (602) 275-8550 (520) 885-2345 (702) 798-3998 87107 84115 Fax: (602) 275-2552 Fax: (520) 770-9999 Fax: (702) 798-4481 (505) 341-1054 (801) 263-3339 Fax (505) 884-0675 Fax: (801) 261-1952 May. 17, 2019 State of Arizona County of Maicopa Isaac School District No. 5 Phyllis Rhyons/To whom it may concern: Cloyee Hudson is the managing collection agent over all of our Arizona accounts and is authorized to sign the Affidavit/Claim Form for a Duplicate Warrant/Check. June Kingston Credit Manager Standard Restaurant Equipment Co. Serving The Fine1t People In The World "Our Customer?