STAMPED AND REDACTED - 3700938198 - CHILDSPLAY.PDF
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Schools Affidavit/Claim Form Application for a Duplicate Warrant/Check (deflnlllone are on page 2) MAR 11 COPA COUNTY ST A TE OF ARIZONA COUNTY OF MARICOPA Note: Numbers on this form correspond to numbers on the Instruction sheet which Is page 2 of this form. Chlldsplay (1), being first sworn, upon oath deposes and says: Name/Clelmant On or about 1/23/2026 (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, Q!'. 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$ 976,00 (3) Signed: Ή (4) Print name: (required) _AΊly_s_o_n_C_ru_z ___________ _ (5) Subscribed and sworn to before me this 2,,.J/ day of Ap:'• I !Pk &'?vv-- NOT ARV PUBLIC My cg7mlrlon expires: "6/2-J 7..] l . --· --·· eil.eN E CONN NO'l'ARVPUe\.lO· Af\lZONA MMICOPACOUNlV COMMISSION I 665981 A MVCOMMmStON exn•• • AUGUST21,?.027 --· ...... ___ , 20,&. (seal) 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 3700938198 (If known) (6) Original Date of Issue 1/23/2026 (If known) (7) Reason for original Issue of Warrant/Check (8): □Payroll lil For Services or Goods furnished Field Trip Performance lil Other: Field Trip Performance S:\Fh1anceDesk\Schools-Warrants Checks notice of clalm.docx Revised May 2025 A.R.S. 11·632 & 15-999