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INTEROFFICE MEMORANDUM _ Maricopa County Schools Superintendent Office D oy own RECEIVED “ ya: CLERK OF THE BOARD FROM: Terri Ysaguirre NOV 24 2020 SUBJECT: Affidavits — Replacement of Lost Warrants MARICOPA COUNTY CLERK BOARD CF SUPERVISORS DATE: 11/23/2020 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. #65 Littleton Elementary Erika A Avelar 5350.55 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form Oe This application is for: [] Duplicate or LJ Stale-Dated (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. Ew\ Koa Rye ay _(1), being first sworn, upon oath deposes and says: Name/Claimant On or about DQ lq ! go DO (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 $250.5 5~ .(3) Signed: Echo hus ? he (4) Note. Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. (5) Subscribed and sworn to before me this __|% day of November 2020, Ela _M. Lezano NOTARY PUBLIC : SLBANL LOZANO My commission expires: B) 18) conmtasion Expres A . November 27, 2021 (seal) Mayember- 21, 2O2\ Warant/Check Number |g LOO27TE YL Sti ea 171220 Reason for original issue of Warrant/Check (8): ~ “TiC Payol 4, NOY 25-7020 OD For Services or Goods furnished PF “6S O Treasurer's refund/payment A6 nL Mattia? O Other: S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of calm - Copy.doc Revised April 2015 ARS, 11-632 & 11-644