STAMPED AND REDACTED - 3700922700 - MONTES SOSA, IRENE Y.PDF

Schools Affidavit/Claim Form 
Application for a Duplicate Warrant/Check (det1111t1ons 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. 
ƓƔlƕre=nƖe_YƗM_o_n_te_s_S_o_s_a __ (l), being first sworn, upon oath deposes and says: 
Name/Cla1mant 
On or about 
November 20, 2025 
(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 $._1_,_6_2_9_.5_9 _______ ,(3)
Signed: 
Ƙ kf;,£/KL 
(4)
(5) Subscribed and sworn to before me this 
ƙ
I 
"i 
day of 
(Yl,(J-.;;t .. <.:- \!--'
C ... 'v\;,J'-
d )L_ 
NOTARY PUBLIC 
My commission expires: 
A£,.:, L ?-1 1 '1,:o'Z.(,, 
\<-----'> ) 
______ ,., 
Michael S Rolnef
-
fLl\- . 
Nolary Publlo
{ liiMN .: Maricopa County, Arizona
'•, ;:-.::: / My Comm. Explros 04-27-26 
.,,, 
Commlsslon No, 624800 
20 2;... , 
(seal) 
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 
3700922700
!If known) (6) 
Original Date of Issue 
November 20, 2025
/if known) (7) 
Reason for original issue of Warrant/Check (8):
ƚ Payroll 
□For Services or Goods furnished. _______________ _
□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