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INTEROFFICE MEMORANDUM 2819 MAY 1 0 All 10: 5:-13,6 Maricopa County Education Service Agency (aka Maricopa County Superintendent of Schools Office) TO: CLERK OF THE BOARD FROM: Terri Ysaguirre SUBJECT: Affidavits — Replacement of Lost Warrants DATE: 5/9/2019 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 y6u 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. #65 Littleton Elementary Dawn Robinson $239.99 Schools Affidavit/Claim Form Application for a Duelicate 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. -2nie)6't4ril\inf' 6CD 6)7) (1), being first sworn, upon oath deposes and says: On or about U Lk V-1 -e \C cI Ndate)(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, gr 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 request that a replacement warrant/check be issued to him/her in the sum of $ 3 9 °I 9 (3) (4) (5ubscrIbed and swonto be/ore me this 3 day of 20 ) 04410-1:e. NOTARY PUBLIC ANAMARIAQUINTANILLA My cgmmission expires: Notary MARICOPA Public • Stets COUNTY of Arizona / S Commission Expires May #545114 16.2022 (seal) 1.1•Az,...-13.1.7•NIMI•eaftc. Note: Please attach a copy of the warrant/check If available and/or any other evidence that a warranVcheck was originally Issued. Warrant/Check Number Of known) (6) Original Date of Issue (if known) (7) for original Issue of Warrant/Check (8): ayroll 0 For Services or Goods furnished 0 Other: SAPROCESSESAWarrants Revised 3une 2015 - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of dalm.doc A.R.S. 11-632 & 15-999