STAMPED AND REDACTED - 3700950446 - FERRIERO, JENNIFER.PDF
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Schools Affidavit/Claim Form Application for a Duplicate Warrant/Check MARCOPA COUNTY (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. _J_E_N_N_IF_E_R_F_E_R_R_IE_R_O ___ (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 03/10/2026 (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, 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 ǃum of $_2;_,2_5_3_.8_6 _____ . (3) Slgned:DŽ/Vkl.DžFdž .. (4) Print name: (required) LJ11() , ¾1 hr[ i e_ o 0 (5) Subscribed and sworn to before me this f<eth day of ma re.h 20 '2v. W\e 2., NOT ARY PUBLIC My commission expires: Juoc 4 , -z.02.ci ROSA MARTINEZ /,,"ii'.sdto Notary Public• State ol Arizona MARICOPA COUNTY Commission fl 686821 E11plros June 04, 2029 (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 3700950446 (If known) (6) Original Date of Issue 03/10/2026 /If known\ /7\ Reason for original issue of Warrant/Check (8): Lj Payroll D For Services or Goods furnlshe.,._ ___________ _ D Other: S:\FlnanceOesk\Schools·Warrants Checks notice of dalm.docx Revised May 2025 A.R.S. IH32 & 15-999