STAMPED & REDACTED EA EDUCATION AVALON INSTITUTE.PDF

MARICOPA COUNTY

Office of Budget and Finance
301 West Jefferson, 9 Floor
Phoenix, Arizona 85003

INTEROFFICE MEMORANDUM

Date: August 16, 2022
To: Clerk of the Board
From: Marcia J. Bulanda

Office of Budget and Finance

Subject: Affidavit - EA EDUCATION INC

Please find attached 1 Affidavit for a stale-dated warrant to be included on the next

available Board Agenda.
e The attached item has been researched to ensure the warrant in question
has not been cashed or previously re-issued.

e The original warrant is lost.

Please call me at if you have any questions. Please return the approved

Affidavit to my attention in the Office of Budget and Finance, 9" Floor.

Thank you.

Re:
FUND 222 — D220 HUMAN SERVICES — GAX1D 22*15727

Application for a Duplicate or Stale-Dated Warrant/ Check

Affidavit/Claim Form

This application is for: Duplicate or (CI state-Dated (definitions are on page 2}

STATE OF ARIZONA Note: Numbers on this form correspond to
COUNTY OF MARICOPA numbers on the instruction sheet which is
paae 2 of this form.

EA EDUCATION INC AVALON INSTITUTE (1) being first sworn, upon oath deposes and says:
Name/Claimant

On or about 04-Feb-2022 (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 $6,000.00 -(3)

}

Signed: tp dake Boe (4)

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

ony. and sworn to before me this _[0*" day of Ava os a

OLY

NOTARY PUBLIC |

RACHAEL FARNELL.
Notary Public - Arizona

mere : Maricopa County
My COMMISSION Expires Commission # 610516

vine 20,2025 SIRES” My Comm. Expires Jun 20, 2025 (seal)

Warrant/Check Numb “
ane eck o. “13010109319

Origina! Date of Issue ; =
Wel next i 04-Feb-2022 sense
Reason for original issue of Warrant/Check (8): J UGK italy aK
C1 Payroll

C2 For Services or Goods furnished

0 Treasuret’s refund/payment
Other: / original check presumed lost in the mail

AVALON INSTITUTE

COSMETOLOGY © ESTHETICS « LASER « MASSAGE

8/10/22
RE: Affidavit/claim for re-issuance of a lost or stale-dated check (warrant)

|, Clint Tryon, authorize April Montes, Corporate Financial Aid Director, to execute and affidavit on
behalf of EA Education Inc. dba Avalon Institute.

Sincerely,

ly—
int Tryon

Chief Financial Officer

Avalon Institute

Corporate Office

COUNTY expense warrant TREASURER OF MARICOPA COUNTY

PHOENIX, ARIZONA

DATE
02-04-2022
Six Thousand And 00/100 Dollars
PAY TO THE ORDER OF
EA EDUCATION INC
AVALON INSTITUTE Void After
365 Days

WARRANT NUMBER
3010109319

91-2/4221

$6,000.00

AMOUNT

For Questions or email NOT NEGOTIABLE
MARICOPA COUNTY DEPARTMENT OF FINANCE
RETAIN THIS FOR | PAYEE WARRANT NO. | WARRANT DATE | WARRANT AMOUNT
YOUR RECORDS

EA EDUCATION INC 3010109319 02/04/2022 $6,000.00
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
123121-210737948 HOPSON MALLON OSY GAX1D D220 220000015727 6,000.00

MALLON 220000015727