STAMPED AND REDACTED - 3700944602 - POINT B GRADING.PDF

Schools Affidavit/Claim Form 
Application for a Duplicate Warrant/Check 
(definition• ere on pege2) 
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. 
-˷P
˸
O˹/N˺T_B_G˻R_A_D_I_NG 
___ (1 ), being first sworn, upon oath deposes and says:
Natne/Clalmant 
on or about 
02/17/2026 
(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 lnadvertehtly lost or destroyed and there Is no reasonable probability of Its 
being found or presented for payment, ru: 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 
to him/her In the sum of $ __ 3_,o_o_o_.o_o __ ˼ (3) 
Slgned:--..ji--h˽""'l-/4..,,!.˾
e:__ _______ (4) 
Print name: (requlred)-B
._..c_,˿̀n ... d,..,o,cO_,! ... S .... 
e,..,'{/,_5
,,_.c_,_
)(\
'-\-, ----
and sworn to before me this £.5 day of(,ln	w.2,(Q 
My commission e:;Llres:
\\ ,IPY! 
́i
.•-• 
_ 
MARIAH FARMER 
_,_Cl .. 1 '!:l11y Puh'";. St3{4 f,f Mzona 
\(;.;j :" 
NAHlOPII GOUN"f"! 
!,;,̂.̃ 
Comrn1irnlon ti 68528.\ 
!l!Y 
Expires M11y 11, 2029 
(seal) 
Note: Please attach a copy of tile warrant/check If available and/or any other evidence 
that a warrant/check was originally Issued. 
Warrant/Check Number 
3700944600, 
/If khownl 16\ 
Orig Ina I Date of Issue 
02/17/2026 
(If known) (7) 
Reason for original Issue of Warrant/Check (B): 
□Payroll
:Kl!'. For Services or Goods furnished ___________ _
□other:
S:\FtnanceDesk\Schoots=Warcants d1ecks notlce of dalm.dOCK 
Revised May 2025 
A.R.S. 11-632 &. JS-999