TOBLER1.PDF

Maricopa County — Formal (2020-12-09)

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INTEROFFICE MEMORANDUM

~ Maricopa County Schools Superintendent Office mu, .
Tne offi
RECEIVED ““
TO: CLERK OF THE BOARD
FROM: Terri Ysaguirre NOV 06 2020
. . . MARICOPA COUNTY

SUBJECT: Affidavits — Replacement of Lost Warrants CLERK BOARD OF SUPERVISORS
DATE: 11/2/2020
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.

#95 Queen Creek Unified Teriney Tobler $58.89 (1 of 3)

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.
E(UNeL ip) (1), being first sworn, upon oath deposes and says:
ame/Claiman
On or about $\aS a) (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 be issued to him/her in the sum of $ BY. $9 (3)

Signed: (4)

4

(5) i a before me this_ 02 day of A4¢nber_20 2p,

NOTARY PUBLIC
DANA SLOAN
My commission exp! RARICORR nee
Wa) Commission # 589174 (seal)
Expires August 9, 2024

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

Ware ee | S06Su rug,

Original Date of ase 4 I Ww ;

Reason for original issue of Warrant/Check (8): OV 12 2020
® Payroll
O1 For Services or Goods furnished
OO Other:

S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc
Revised June 2015 A.R.S. 11-632 & 15-999