STAMPED AND REDACTED - 3700942648 - TSA CONSULTING GROUP.PDF

Schools Affidavit/Claim Form 
Application for a Duplicate Warrant/Check 
(definitions are on page 2) 
ST ATE OF ARIZONA 
Note: Numbers on this form correspond to numbers on the
COUNTY OF MARICOPA 
Instruction sheet which is page 2 of this form. 
-r-:iA C C1, 
(1), being first sworn, upon oath deposes and says: 
Name/Claimant 
1 
_ . I 
On or about02/ ( ()/:2.0'.lcp (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. 
(5 Subs@ bed and swon;i.to before me this i$Ȓay of /Yl.o.cch 20ȓ 
My commission expires: 
,3·,Q'R· Jg 
LESLIE W. STEVENSON 
Commlss5n # HH 49-0872 
Expires March 28, 2028 
(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
lit known\ /6\ 
Original Date of Issue
(if knownl /7\ 
•) i-1 .-
·- q I i2 {t  r,
,) 
l)l) · .!.,-- ,, .) -·('.J 
()2/ I[>/ :'.2D2(JJ 
Reason for original issue of Warrant/Check (B): 
□ Payroll
□For Services or Goods furnished, _____________
□Other:
S:\FlnanceDesk\SchoolsAWarrants Checks notice of clalm.docx 
Revised May 2025 
A.R.S. 11-632 & 1S-999