STAMPED AND REDACTED - 3700916214 - MUSIC & ARTS CENTER.PDF

Schools Affid?vil:/ Claim Form 
Application for a Duplicate Warrant/ Check (definitions are on page 2) 
STATE OF ARIZONA 
COUNTY OF MARICOPA 
Nole: Numbers on this form correspond lo numbers on the 
lnslruclion sheet which is page 2 of this form. 
Music & AIts Center, _____ (1), being first sworn, upon oath deposes and says: 
Name/Claim an! 
On or about _1QR3J2025 
(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 inadveItently 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 $.-"'.J1 ""1""68""'"'02.͝
----· (3) 
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Signed: 
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.,,.¸{A'1,,,t/1J,
I 
(4) 
(',, r.;,_1bs1s:!'),;d ::md sworn t,:, l:,efor· ,.¹., :h!- J.'). ͞ ,( r'0•: :;f fd./4t.,1.1f-, 20/f. •·
• 
, / .e! t2"1/J-1J.---
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KARLA JEAH BEL TOH 
My commlssio exp es: 
Hota,y Pvbllc. State of Ma land 
,! 2,;, 
t,.?f 
\ 
Fredorl 
 
nty 
l=====/==cl====-------------e;W!%mu,r.Joo.£lcp\'ri/iJ.wg.;jo, 2028 
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. ,.,"'J͟ p_!;e: Please attach a copy of the warrant/check If available and/or any other 
••••• evidence that a warrant/tl're'ckW,fs͠ drltj'itraily·Issued, 
-͡
- ---- -·- -•--·---•-·
Warrant/Check Number 
3700916214 
(If known) (6) 
Original Date of Issue 
10/23/2025 
(If known) (7) 
Reason f,.,; ')riy:nal !ºGW 1.):' \fl/,!ff311i/Cl,e•,k (8): 
D Payroll 
Gil For Services or Goods furnished: Music & Arts Center 
□·other: Music & Arts Center
S:\PROCESSES\Warrantr.- D11plicate o\ S\ale\02 Forms\Schoo!s\Schools•Warrants Checks notice of claim.doc