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INTEROFFICE MEMORANDUM Maricopa County Schools Superintendent Office TO: CLERK OF THE BOARD FROM: Terri Ysaguirre SUBJECT: Affidavits —- Replacement of Lost Warrants DATE: 12/13/2021 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. #65 Littleton Elementary Rhayne D Moorcones $66.36 RECEIVED DEC 15 2021 MARICOPA COUNTY CLERK BOARD GF SUPERVISORS Tater offer wok AF Schools Affidavit/Claim Form Application for a Duplicate Warrant/Check (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. fags QA Voortone 5 (1), being first sworn, upon oath.deposes and says! On or about __/ehrwans 5,YaY (dete\(2) a warrant/check was Issued to the above named person/entity’in the amount as stated below. Such warrant/check was either never recelved 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 $_@@.« 77% (3) Signed: 222 =n (4) Zed day of December 2021, (5) Subscribed and sworn to before me this UN aur D Kure NOTARY PUBLIC J » _MARIAD, KRIEGER ©) Notery Public - State of Arizona fF) MARICOPA COUNTY SY Commission # 597013 Expires February 01, 2026 (seal) My commission expires: Februar Ol, 2025 Note. Please attach a copy of the warrant/check If avallable and/or any other evidence that a warrant/check was originally Issued, Warrant/Check Number Ate . ; (if known) (6) 2 7OOQBONG bo Original Date of Issue a (if known) (7) Lebrue ry 5, S202) Reason for original issue of Warrant/Check (8): Sg Payrl D For Services or Goods furnished / Vl 21/2021 O Other: S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc Revised June 2015 ARS. 11-632 & 15-999