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INTEROFFICE MEMORANDUM endent Office copa ‘County Schools Sup TO: CLERK OF THE BOARD FROM: Terri Ysaguirre SUBJECT: Affidavits ~ Replacement of Lost Warrants DATE: 11/18/2020 Please find attached 1 Affidavit/Notice of Claim(s) for lost warrants for inclusion on the next avallable 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. lf you have any questions, please contact Terri Ysaguirre at 602-372-1245 or via e-mail at terri. ysaguirre@maricopa.gev. Approved Affidavits may be routed back to the Superintendent of School Finance Division at 4041 N. Central Avenue #1200, (12th Floor) Thank you. #9 Wickenbueg Unified Darcy L Komen $425.38 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. Da recy L. K omen (1), being first sworn, upon oath deposes and says: Name/Claynant On or about /; 1D | AWWAO (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 ho 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 bars that a replacement warrant/check be issued to him/her in the sum of §. “f 25. ze (3) Signed: f Whe Hemos (4) (5) Ta and sworn-to before me this vi x Tay of Navereher- 20). Ld NOTARY PUBLIC NOTARY PUBLIC - ARIZONA | MARICOPA COUNTY COMMISSION # 588026 MY COMMISSION EXPIRES AUGUST 16, 2024 My commission expires: 5 [ofa (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 ; peck (6) 3700370 373 Original Date of Issue ? (if known) (7) l \/1v[A0do Reason for original issue of Warrant/Check (8): son fe ‘, )piovg sme C For Services or Goods furnished O Other: §:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc Revised June 2015 ARS. 11-632 & 15-999