STAMPED AND REDACTED - 3700944754 - HARRIS, BENJAMIN RYAN.PDF

Schools Affidavit/Claim Form 
Application for a Duplicate Warrant/Check (definitions are on page 2)
STATE OF ARIZONA 
Note: Numbers on this form correspond lo numbers on the 
COUNTY OF MARICOPA 
Instruction sheet which is page 2 of this form. 
HARRIS, BENJAMIN RYAN 
Name/Claimant 
(1
)
, being first sworn, upon oath deposes and says:
On or about 2.. / I r /2.. b
(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, Qt 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
::ǽ::Ǿ/c
he
ǿȀ-
ȁ;,iȂ;ued to
ȃȄer iȅ $_5_1_0_.4_8 _____ 
(
_
4
_
) 
__ ,
(
3)
---
(5) Subs r, bed and sworn to before me this
My commission expires: 
/1 /IS/39 
( ot:b day of (Y\ (]\/ CY) 
20Ȇ
= 
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 
(If known) (6) 
Original Date of Issue 
/If known l (71 
3700944754 
02/17/2026 
Reason for original issue of Warrant/Check (8): 
Iii 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