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INTEROFFICE MEMORANDUM
~ Maricopa County Schools Superintendent Office
JY
RECEIVED {{",
TO: CLERK OF THE BOARD ECEIVED x
FROM: _ Terri Ysaguirre OCT 27 2029 ©=0 a?
SUBJECT: Affidavits — Replacement of Lost Warrants MARICOPA CCUNTY
CLERK BOARD OF §
DATE: 10/21/2020 UPERVISORS
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.
#33 Buckeye Elementary Rebecca B Williams $900.00
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.
Kebe ALL AL LW, T yi ams , (1), being first sworn, upon oath deposes and says:
ame/Claiman
On or about 9 /'s /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 $ GLP, 2 (3)
Signed: bf batty Lb LAND (4)
(5) Subscribed and sworn to before me this_I@-th_day of October 2020.
buh U Khadr
NOTARY PUBLIC ~”
GER APRIL A RHODES,
3/ EA Notary Public - Arizona
en A . i DESRER JB) Maricopa County
My commission expires: Commission #555900
D c. So Wit My Comm. Expires Dec 3, 2022 (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 ;
(if known) (6) 3100350 QB5
Original Date of Issue
(if known) (7)
Reason for original issue of Warrant/Check (8): OCT 29 2020
O Payroll
(. 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
Rebecca B. Williams
October 12, 2020
Buckeye Elementary School District #33
Accounts Payable
25555 W Durango Street
Buckeye, AZ. 85326
To Whom It May Concern:
After speaking with your department on 10/5/2020 it was discovered that my check for Invoice
# FY2021 001 was mailed to the incorrect address on or about 9/3/2020. The check was not
received by me or returned to the Buckeye Elementary School District Office. | respectfully
request a reissue of the warrant.
Thank you for your help in this matter.
Sincerely,
Ge bue rab Webern?
Rebecca B. Williams
Consultant
Rebecca Williams
TO:
Buckeye Elementary School District # 33
25555 W Durango Street
Buckeye, AZ. 85326
Phone: 623-925-3442
INVOICE
INVOICE # FY2021 001
DATE: AUGUST 30, 2020
Make all checks payable to Rebecca Williams
SALESPERSON P.O. NUMBER REQUISITIONER SHIPPED VIA | F.0.B. POINT TERMS
210501 Bonita Tatum
QUANTITY DESCRIPTION UNIT PRICE TOTAL
12 HRS. On Site Work for Medicaid Audit 2020 $75.00 $ 900.00
SUBTOTAL
SALES TAX
SHIPPING & HANDLING
TOTAL DUE $900.00
If you have any questions concerning this invoice, contact Rebecca Williams @ fC
THANK YOU FOR YOUR BUSINESS!
Warrant Number - 3700350885
i : Status Issued
| Account # ee...
| | Paid Date
Issued Date 09/03/2020
Registered Date
Payee Rebecca B. Williams
- Amount $900.00
Interest $0.00
“Claim #
Sub Fund
: Dept #
_PO#
LowOrig
Voucher 1030