STAMPED AND REDACTED - 3700941159 - TARTAN OIL LLC.PDF

Schools Affidavit/Claim Form 
Application for a Duplicate Warrant/Check 
( definitions are on page 2) 
STATE OF ARIZONA 
COUNTY OF MARICOPA 
Note: Numbers on this form correspond to numbers on the 
Instruction sheet which is page 2 of this form. 
_T_a_rt_a_n_O_i_l ______ (1 ), being first sworn, upon oath deposes and says: 
Name/Claimant 
On or about 02/02/2026 
(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, QI 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 
im/her in the sum of$ 20,541 .32
. (3) 
Signed: _;,ɒ;zr:1!:lL.ɓɔ'.'.'.'..",,-C'.ɕ:::::ifɖz...ae-==:::::==ɗ ( 4) 
Print narne: (required) _J_o_h_n_L_. R_u_s_s_e_l_l _________ _ 
NOTA!fY' PUBLIC 
My commission expires: 
07.Jo':'o lwv1 
r 
I 
2o·i&. 
00,//11/ffl 111 \\ \\"1 ()'l: 
Note: Please attach a copy of the warrant/check if available and/or aXY'IJrtfYP evidence 
that a warrant/check was originally issued. 
Warrant/Check Number 
3700941159 
(if known) (6) 
Original Date of Issue 
02/02/2026 
/if known) /7) 
Reason for original issue of Warrant/Check (8): 
□Payroll
□For Services or Goods furnished, ____________ _
!!!l Other: 
_F_u_e_l _P_aRym_e_n_t ______________ _ 
S:\FinanceOesk\Schoo!s-Warrants Checks notice of dalm.docx 
Revised May 2025 
A.R.S. 11-632 & 15-999