STAMPED & REDACTED - RICARDO DIAZ.PDF

v
MAR)COPA
COUNTY

INTEROFFICE MEMORANDUM

TO: MARICOPA COUNTY CLERK OF THE BOARD
FROM: MCSS FINANCE DESK (MIKE MARTINEZ)
SUBJECT: AFFIDAVITS - REPLACEMENT OF LOST WARRANTS

DATE: 10/17/2025

Please find attached 1 Affidavit/Notice of Claim(s) for lost warrants for inclusion on the
next available Board agenda.

The attached item(s) have been researched to ensure that the warrant(s) in question
have not been cashed or previously re-issued.

The original warrant(s) have had a stop payment done.
If you have any questions, please contact the MCSS Finance Desk at 602-372-4833
(Option 1) or via e-mail at FinanceDesk@maricopa.gov. Approved Affidavits may be

routed back to the Superintendent of Schools - Finance Desk at 4041 N. Central Ave
#1100.

Thank you

District Payee Warrant # Amount

Avondale Elementary #44 _| Diaz, Ricardo 3700823561 $116.55

Application for a Duplicate or Stale-Dated Warrant/ Check
Affidavit/Claim Form

This application is for: Duplicate or CL stale-Dated (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.
DIAZ, RIC ADO (1), being first sworn, upon oath deposes and says:
On or about 11/22/2024 (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 sum of g 116.55 (3)

Signed: calle (ke (4)

Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.

(5) Subscribed and sworn to before me this 14 day of OCH Deje 20 26

: VARMA
NOTARY PUBL |

My commission, expires:
05/21 Jon

” RITAM, LUPIAN

BR
\ Notary Public - Arizona
La) Commission x4

Sie

Warrant/Check Number
(if known) (6) 13700823561
Original Date of Issue
(if known) (7) 1 1/22/2024 ; 10/17/25

Reason for original issue of Warrant/Check (8):
i) Payroll

1 For Services or Goods furnished
(1 Treasurer’s refund/payment
Other:

S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc
Revised April 2015 ARS. 11-632 & 11-644

Warrant (1 - mcto) - Warrant number: 3700823561, Stopped

Warrant

Warrant Status Print Attachments

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Maintain New Status Setup Attachments
3700823561
4 Warrant header
Warrant number: 3 61 Invoice:
Holder: Invoice date:
Issued date: 11/22/2024 12:00:00 am Paid date:
Status: Stopped Positive pay sent date: 11/21/2024 09:00:22 am
colon flag:
t son:
ioctl _ mene Agency voucher number: 21
Queued for positive pay: Agency claim number:
: Agency low orig:
Locked for reconcile: Agency PO number: re)
Registered Agency sub fund:
Date registered: Agency dept num:
No of days interest: 0
Annual interest rate: 0.00000
4 Warrant Lines
oO Amount Payee Account

Iq <do m DI | A | © | Identification of the warrant