Extracted text (via pymupdf_layout)
2637 characters
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: 1/30/2019 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. #401 EVIT Tina M Gallegos $380.22 RECEIVED JAN 3 1 2019 MARICOPA COUNTY CLERK BOARD OF SUPERVISORS i/6 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 Instruction sheet which is page 2 of this form. COUNTY OF MARICOPA TWA M., 4 ue (1), being first sworn, upon oath deposes and says: Name/claimant On or about er)F-..6. L O (date)(2) a warrant/check was issued to the above named person/entity in the amount as stated beloIN__ Such warrant/check was either never received or was subsequently inadvertently (c_2or 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 issued t im/her in the sum of $ 5304;2-2_- .( 3 ) (4) Signed: /) 1-11 (5) Subscribed and sworn to before me this 0/ .6 day of /7 0 /1/j JZZ NOTARY PUBLIC BARBARA OFFICIAL SPIELBUSCH SEAL — NOTARY PUBLIC- STATE OF ARIZONA MARICOPA COUNTY My commission expires: My Comm. Expires March 2, 2022 (seal) 722(PieA Note: Please attach a copy of the warrant/check if available and/or_any other ,1LI/trcc itivit.awr trtv4,.. APP . 1 2019 DAT r- Warrant/Check Number 51 co 1 2_2 ,k2--cf (if known) (6) Original Date of Issue 1:2_ 1 -2_,I;D‘ (If known) (7) 1De 9e.) Reason for original issue of Warrant/Check (8): fp Payroll c‘i. .\\AVAicktugb b For Services or Goods furnished A )ther: S: \ PROCESSES \Warrants - Duplicate or Stale \02 Forms \Schools \Schools-Warrants Checks notice of claim.doc A.R.S. 11-632 tk 15-999 Revised June 2015