STAMPED & REDACTED - MICHELLE R. WATSON.PDF
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INTEROFFICE MEMORANDUM TO: MARICOPA COUNTY CLERK OF THE BOARD FROM: MCSS FINANCE DESK (MIKE MARTINEZ) SUBJECT: AFFIDAVITS – REPLACEMENT OF LOST WARRANTS DATE: 11/03/2022 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 (Option 1) or via e-mail at . Approved Affidavits may be routed back to the Superintendent of Schools - Finance Desk at . Thank you District Payee Warrant # Amount Tolleson Elem Dist #17 Michelle R. Watson 3700574956 $320.42 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. _M ...... i.-c_he_,1_1e,.....R __ . W"?"-a_ts_o_n ______ (l), being first sworn, upon oath deposes and says: Name/Claimant On or about q j J s} 20-2 .:l ... (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 $_3_2_0_.4_2 _______ .(3) Signed: « ¬ (4) (5) Subscribed and sworn to before me this \ day of 1-JOV0.-!\®20J.,:l-.. ¯A(1W'° l.ez._ NOiAA.rPUBLIC My commission expires: ij\\1\±:z.3 (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 3700574956 (if known) (6) Original Date of Issue 09/13/2022 (if known) (7) 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 11/3/22, 2:51 PM VMware Horizon https://horizon.maricopa.gov/portal/webclient/#/desktop 1/1