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INTEROFFICE MEMORANDUM
Maricopa County Schools Superintendent Office
TO: CLERK OF THE BOARD
FROM: Terri Ysaguirre
SUBJECT: Affidavits - Replacement of Lost Warrants
DATE: 10/20/2020
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.
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.
#401 EVIT Creative Concepts International $608.29
DS.
RECEIVED “ers
OCT 30 2020
MARICOPA 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 Instruction sheet which is page 2 of this form.
m
rN
Creative Concepts International (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 05/05/2020 (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 $608.29 (3)
@@F Subscribed and sworn to before me this 26" _day of Agus 2022 .
NOTARY walt
My commission expires:
GBOMEO jo (03/2073
CHEYENNE PESHLAKAI
Notary Public - Arizona
Pima County.
Commission #570614
My Comm, Expires Oct 3, 2023 (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 3700312269
(if known) (6)
Original Date of Issue 05/05/2020
(if known) (7)
Reason for original issue of Warrant/Check (8):
O Payroll
i For Services or Goods fu
Other; Siete:
rnished Shirts
§;\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc
Revised June 2015 ARS, 11-632 & 15-999
Creative Concepts International
Lages in Mction
Promotional Products . Corporate Apparel . Printing,
8/27/20
To whom it may concern
| am writing this letter in regard to check #3700312269. We never received the check on 5/5/20. | have
attached the affidavit to this letter as well
Thanks,
Qwer
12895 N Carpas CT, Marana — AZ 85658 PHONE 520 977-8885 / FAX520 777-0181
THIS DOCUMENT CONTAINS A TRUE WATERMARK - HOLD TO LIGHT TO VIEW
re 05/05/2020 401647742 | 2
East Valley Institute of Technology District #401 s
PAY WARRANT AMOUNT &
**Six Hundred Eight and 29/100" Dollars $608.29 3
: VOID AFTER 365 DAYS g
TO CREATIVE CONCEPTS INTERNATIONAL J g
THE 7471 N. BRADSTREET DR ‘le, . €
ORDER TUCSON, AZ 85743 C.) E
, oud 5 io 3
OF SY ice sore |
w37003a22BU" waecekbOOO dkny 97039493"
Te cruani@ . pumeNy amvona 08/05/2020 Check: 401647742 EXPENSE
MARICOPA COUNTY SCHOOLS +- PHOENIX, ARIZONA AP-20200506 3700312269
a |
CREATIVE CONCEPTS INTERNATIONAL | |. 05/05/2020 _| | |
Payee | | Check Date | }
Account Number PO Number Invoice Amount
00135312146611201 2001087 «8418 608.29
{
|
_ _ _ — |
VOUCHER: 1099 TOTAL: $608.29
HARLAND CLARKE 22692 90325231