HAGLER.PDF

Maricopa County — Formal (2020-12-09)

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INTEROFFICE MEMOBANDUM

Maricopa County Schools Superintendent Office

FO: ELERK OF THE BOARD

PROM: = Terr ¥saguirre

SUBJECT: Affidavits ~ Replacement of Lost Warrants
BATE: 14/25/2020

Please find attached 1 Affidavit/Notice of Claim(s) for lost warrants for inclusion en the next
available Beard agenda

v ‘The attached item(s) have been researched to ensure that the warrant(s) in queation have
not been cashed or previously re-issued.

¥ The ariginal warrant(s) have had a step payment dane,

lf you have any questlens, please contact Terri ¥saguirre at 602-372-1245 ar via gmail at
terri.ysaguirre@maricopa.gov. Approved Affidavits may be routed back to the Superintendent
of Scheol Finanee Division at 4041 N, Central Avenue #1200, (12th Floor)

Thank yeu,
HOS Queen Creek Unified Carolyn € Whiting $471.28

#95 Queen Creek Unified Jill M Hagler §932,08

RECEIVED Doraw
NOV 3 0 223

MARICOF-A COUNTY
CLERK BOARD OF SUPERVISORS

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.

Jill Michelle Hagler (1), being first sworn, upon oath deposes and says:
Name/Claimant

On or about 11/3/20 (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 $ 932.09 s(3)

Signed: QO (a ia = (4)
(To

(5) sugetibed and sworn to before airy l J day of 1 iv qembso 3.0

NOTARY PUBLIC
DONNA WATERS
iat : Notary Public - State of Arizona
My commission expires: MARICOPA COUNTY
4443/20 + Z Commission # 577778
< i Expires February 4, 2024 (seal)

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

Wrenfgman io” [3700368805

Original Date of Issue
: (if known) (7) 1 1 /3/20

Payroll

“Fe for original issue of Warrant/Check (8):

For Services or Goods furnished
O 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