STAMPED & REDACTED COLIBRI COLLECTIVE.PDF

INTEROFFICE MEMORANDUM

Maricopa County Schools Superintendent Office

TO: CLERK OF THE BOARD

FROM: Terri Ysaguirre

SUBJECT: Affidavits - Replacement of Lost Warrants
DATE: 12/17/2021

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.

Vv 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.

#31 Balsz Elementary Colibri Collective $6,415.00

Schools Affidavit/ Claim Form

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

STATE OF ARIZONA Note: Numbers on this form corraspond to numbers on the
COUNTY OF MARICOP, Instruction sheet which Is page 2 of this form.

Gabon ele Cr LYE, being first sworn, upon oath deposes and says:

Narie/Clalmant

On or about _ 11 [iO £2.02 \ (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 rau Cy in the sum gf $. lo, y 15.0° (3)

Signed: (4)
(5) Subscribed and sworn to before me this b day of December 20,22,
2 CAD cpg ZL
NOTARY PUBLIC
GENEVIEVE MARIE LEACH
My commission expires: g ye Moteopa County
Bibi (2029 oo oe (seal)

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

erento | SAOOH4Y OZ 22
one rea | V [10/ 2021
Reason for original issue of Warrant/Check (8):
Payroll
(] For Services or Goods furnished 12/21/2021

of Other: -

S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks
Revised June 2015 ARS. 11-632 & 15-999

THE COLIBAL SQ COLLECTIVE

December 14, 2021

Office of the Maricopa County School Superintendent,

This letter confirms that The Colibri Collective did not receive check # 3700486338 from
Baisz School District for the amount of $6415.00, dated 11/10/2021. This check was
mailed to a PO Box that has been closed for over fifteen months.

| am the sole owner of The Colibri Collective LLC and an authorized signer for the

company.

Regards,

Gaby Cardenas
CEO- Founder
The Colibri Collective