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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: 11/3/2020 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. 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. #5 Isaac School District Mckenna R Symons $1,121.61 RECEIVED NOV 04 2020 MARICOPA COUNTY CLERK BOARD OF SUPERVISORS Lio Me\ Ae Schools Affidavit/Claim Form Application fora 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. McKenna. fe. Syms (1), being first sworn, upon oath deposes and says: Name/Claimant On or about ah g fe0t0 (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 $ //2l ‘ @ / (3) Signed: \AW1 ere. Sey (4) before me this 2O™ day of OCT9bL1 29 20. (5) Subs¢ribed and sworn NOTARYPUBLIC OROZIEZINS S0xdg UORSEILLION Avy ar Maro Sh ical 96H0ZS ‘ON UO}SSILUWIOD as : . . - AA Se SON f RICOPAC INTY ! VNOZINV - id 0: My DA. OE al feosvieW S SueW ai ea" Pane soe m00 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 27003 SSOEF S (if known) (6) Original Date of Issue ; (if known) (7) O 112g e000 Reason for original issue of Warrant/Check (8): AT Payroll O For Services or Goods furnished O Other: LVIE ~STERK, BOARD OF SUPERVIS ‘ORS MARICOPA COUNTY 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