BRADY INDUSTRIES.PDF

Maricopa County — Formal (2020-09-16)

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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: 8/31/2020

Please find attached 1 Affidavit/Notice of Claim(s) for lost warrants for inclusion on the next
available Board 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.

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.

#402 West-MEC Brady Industries $59.31

tio Ba,
RECEIVED
SEP 02 2020

MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS

State oF NEVABE rf

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.
Rye au Badush “\@ (4), being first sworn, upon oath deposes and says:
Name/Claimant
On or about Yorn 4 fake) QO (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

<0
warrant/check be issued to him/her in the sum of $ SOA. SN (3)
Signed: Li ls 4 (4)

COUNTY oF CLARY

(5) Subscribed and sworn to before me this (1 aay of AVGUST 20.20.

NOTARY PUBLIC

TRISHA BRANDONISIO
NOTARY PUBLIC
STATE OF NEVADA
Saggy My Commission Expires; 04-04-23
Certificate No: 19-2032-1 (seal)

My commission expires:
ou | 04 12023

Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.

- —
heck b - . — rs no ann |
WarrantjCheck Number | 35- OO AXA A'S SEPYO 2 7 si |
Original Date of Issue - ; a
9 (if known) (7) 3 | a | AG AO Go Yh Varia
Reason for original issue of Warrant/Check (8):
0 Payroll

For Services or Goods furnished. C “wy Skok al Pena ucts
O Other:

*\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of clalm.doc
are aS ‘ A.R.S, 11-632 & 15-999

RECEIVED
AUG 24 2020