STAMPED AND REDACTED - FOR AGENDA ATTACHMENTS - 3700931048 - LORI CYNOVA.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 to numbers on the 
COUNTY OF MARICOPA 
Instruction sheet which is page 2 of this form. 
CYNOVA, LORI A 
(1), being first sworn, upon oath deposes and says: 
Name/Clalmanl 
On or about 
\ 'd. \ 'd-3) 'd.od->S. 
(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, QI 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 $531.17 
.(3) 
\J, 
' I/ . 
l '. 
----------· 
Signed: 
u ,2 it} U 1·-f !!l O v:A/
(4) 
(5) 
7)
bed and sworn to before me this 
NOTARY PUBLIC 
C/\SS/\NDHA l<ENNl'UJ 
Notary Pu.bliG - Btale ol Arizonri 
PINAL COUNTY 
Comrrii-st,ion # 62\JO'.lA 
l:Y.flff(t5 w,;,_• 8, 2026 
(seal) 
Note: Please attach a copy of the warrant/check ff avallab/e and/or any other 
evidence that a warrant/check was orig/na//y Issued 
Warrant/Check Number 
3700931048
(If known) (6) 
Original Date of Issue 
12/23/2025 
!if knownl 171
Reason for original issue of Warrant/Check (8): 
lil Payroll 
D For Services or Goods furnished ______________ _ 
D Other: ------------------------
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\SChools-Warrants Checks notice of claim.doc 
Revised June 2015 
A.R.5. 11-632 & 15-999