STAMPED & REDACTED CHALLENGE ISLAND CHANDLER.PDF

Maricopa County — Formal (2022-01-12)

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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

v 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.

#95 Queen Creek Unified Challenge Island Chandler $1,250.00

RECEIVED

DEC 15 2021

MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS

Falor ofliee teal -AE

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.

Stephanie Edwards DBA Challenge Island Chandler (1) being first sworn upon oath deposes and says:
Name/Claimant " ‘

On or about December 1, 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.

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/cheok be issued to him/her in the sum of $ 1250.00 (3)
} .
Signed: Aidan 10 Duy Oiol— (4)
iv

(5) Subscribed and sworn to before me this__ _ _day of Decemleew 2021.

NOTARY PUBLIC Va

My commission expires: 7 / 27 / 2025

December 1, 2021

Nolary Public - State of Arizona
MARICOPA COUNTY
Commission # 610652

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 3700484804

(if known) (6)

Original Date of Issue : .
hare invoice date 10-22-2021

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

0 Payroll
For Services or Goods furnished_10-22-2021 12/21/2021
1 Other: 10-22-2021 : -

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

Challenge Island Chandler
Stephanie Edwards- owner

December 7, 2021
Dear QCUSD,
This letter is to inform you that I am the owner representative of Challenge Island
Chandler authorized to sign for the entity asking for a warrant check replacement
#3700484804. I completed the form with a notary to have a re-issue of lost/not
received check in the amount of $1,250.00 for a field trip at Desert Mountain
Elementary on October 22, 2021.
My invoice number was #108 billed directly to the school attention of Michele Olsen.
If you should need anything further please let me know.
Sincerely,

Stephanie Edwards