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INTEROFFICE MEMORANDUM Maricopa County Schools Superintendent Office TO: CLERK OF THE BOARD RECEIVED FROM: Terri Ysaguirre JUN 1 3 2019 SUBJECT: Affidavits — Replacement of Lost Warrants MARICOPA COUNTY DATE: 6/13/2019 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. #201 Buckeye Union Antonio T Mendoza $2,757.62 #214 Tolleson Union Nearpod Inc $5,850.00 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. Nearpod Inc (1), being first sworn, upon oath deposes and says: Name/Claimant On or about October 9, 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 $ 5850.00 , .(3) Signed: verk. Ce 19 (4) VP sf4 (5) Subscribed and sworn to before me day of —I-kik-Re_ 20_ 1 Ca4ke/co, NOTARY PUBLIC 4074',4,, CATHERINE L. PATTERSON sE0 Notary Public • State of Florida My commission expires: 1...k• Commission # GG 235792 —1 My Comm. Expires Jul 8, 2022 L (seal) ........... Bonded Mrough National Notary Assn. I 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 3700096418/214752388 (if known) (6) Original Date of Issue 10/9/18 (if known) (7) — IR ir M" VS A F Frt whir Reason for original issue of Warrant/Check (8): JUN4 4 Mg 0 Payroll • For Services or Goods furnished r C,OuN 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 6/4/19 To Whom It May Concern: This letter is to verify that the person signing this affidavit Severine Vieux, is authorized to do so on behalf of Nearpod, Inc. she is the VP of Finance. Phone 1-855-NEARPOD (632-7763)1 Fax 305-655-199911855 Griffin Road, Suite A290, Dania Beach, FL 330041 www.nearpod.com