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INTEROFFICE MEMORANDUM 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: 4/15/2019 #2 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. #95 Queen Creek Unified Lola Hunt $89.65 #95 Queen Creek Unified Lola Hunt $89.65 REc 1\ ETT' AP 16 IARIC.30PA GUMP: CLERK BOARD OF SUPERV;SORS 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 ,OF Instruction sheet which is page 2 of this form. Name/ 'laiman k AV) (1), being first sworn, upon oath deposes and says: On or about 0 2-0 ( (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 strn of $ (DS .(3 ) I Signed: '/ (4) (5ubscribed and sworn to before me this 1 C4b day of 20 )q. 16/ ( NOTARY t)iLIC JENNIFER D. YOUNG pp, y commission expires: Notary MARICOPA Public - State COUNTY of Arizona I \ / do My Commission April 11, 2022 Expires (seal) Note: Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check - was originally issued. c't5b-144-1 Original Date of Issue (if known) (7) n n • P.1 .11141 Reason for original issue of Warrant/Check (8): X Payroll LI For Services or Goods furnished 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