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INTEROFFICE MEMORANDUM / Maricopa County Schools Superintendent Office — YO: CLERK OF THE BOARD FROM: Terri Ysaguirre SUBJECT: Affidavits ~ Replacement of Lost Warrants DATE: 11/28/2020 Please find attached 1 Affidavit/Notice of Claim(s) fer lost warrants for inclusion on the next available Beard 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 terr.ysagulrre@maricopa.zov. Approved Affidavits may be routed back to the Superintendent of Scheol Finance Division at 4041 N. Central Avenue #1200, (12th Floor) Thank yeu, #95 Queen Creek Unified Shawndra R Bird $1,518.10 (1 of 2) #95 Queen Creek Unified Shawndra R Bird $1,518.10 (2 of 2) Pris Queen Creek Unified Laurence E Bird $1,828.34 DS RECEIVED 2 hac NOV 8 0 2028 MARICOPS 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. Laurence Edwin Bird (1), being first sworn, upon oath deposes and says: Name/Claimant On or about lif fal eee) (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 == to him/her in the sum of $ 1,828.34 (3) ianed: ee en ee (4) Signed; ~ (5) Subscribed and sworn to before me this Vio" day of Aavember 20.20. Vi = NOTARY PUBLIC digs commie q, Sof DANA SLOA\ nau, set on 1 Commission # B0174 (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. Wi t/Check Numb arent Gieccnombes a 700372024 Original Date of Issue (if known) (7) 1 1/1 7/20 Reason for original issue of Warrant/Check (8): V 3,0 2020 @ Payroll O 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