STAMPED & REDACTED MARIA ECK.PDF

INTEROFFICE MEMORANDUM

Maricopa County Schools Superintendent Office

TO: CLERK OF THE BOARD

FROM: Terri Ysaguirre

SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 12/16/2021

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

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

v The original warrant(s) have had a stop payment done.

If you have any questions, please contact Terri Ysaguirre at 602-372-1245 or via e-mail at
terri.ysaguirre@maricopa.gov. Approved Affidavits may be routed back to the Superintendent
of School Finance Division at 4041 N. Central Avenue #1200, (12th Floor)

Thank you.

#33 Buckeye Elementary Maria Eck $4,641.25

Schools Affidavit/Claim Form -

Application for a Duplicate Warrant/ Check (definitions are on page 2)

Ly

STATE OF ARIZONA [/, ante Note: Numbers on this form correspond to numbers on the

COUNTY OF MARIGOPA Instruction sheet which is page 2 of this form.
Maria Eck rat

Name/Claimant
On or about November 15, 2021 (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.

(1), being first sworn, upon oath deposes and says:

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 4,641 25 (3)

signed XY Quan. | (4)

(5) Subseribed and sworn to before me this [ (May of Lilet 204 (_,
js

gone

WARY PUBLIC

ANN ELIZABETH NEWSOME
NOTARY PUBLIC
soe : REG. 17603782
SI € : COMMONWEALTH OF VIRGINIA
y commis on PAPI MY COMMISSION EXPIRES AUGUSY 31, 8622
November 15,2021 (seal)

Cyauat a, UA Q

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 3700486618/33627080

(if known) (6)

Original Date of I
‘eriaen [November 15, 2021

Reason for original issue of Warrant/Check (8):
C1 Payroll

For Services or Goods furnishedGonsulting 12/21/2021

CO Other: Consulting :

S:\PROCESSES\Warrants ~- Duplicate or Stale\02 Forms\Schools\Schools-Warrants Che
Revised June 2015 Tse! eae aes

INTEHEST STOPS ON DATE FUNDS AVAILABLE. (SEC 11-636, ARS1956)

Buckeye Elementary District #33
PAY

*“Eour Thousand Six Hundred Forty One and 25/100** Dollars

fo Maria Eck
(HE

IRDER

OF

ant

THIS WARRANT DRAWS INTEREST FROM DATE MARKED "INSUFFICIENT FUNDS*

aot Meng

BN /$
, Poy 3h

CONTHOL

£ Wahson
supetntenden SFR ZED SIGNATURES

| _DATE NO |:
41/45/2024 33627080|
WARRANT AMOUNT ft
$4,641.25 i

VOID AFTER 365 DAYS :

MARICOPA COUNTY SCHOOLS + PHOENIX, ARIZONA

44/16/2021 Check:

33627080 EXPENSE

AP 20211115 3700486618
Maria Eck : 11/15/2021_| |
Payee _ Check Date | {
Account Number PO Number Invoice Amount
220800" 00022~°" ~*~ 4,641.25 ~ ~
VOUCHER: 4102 TOTAL. $4,641.25