Extracted text (via ocr_local)
4165 characters
INTEROFFICE MEMORANDUM
Maricopa County Schools Superintendent Office
TO: CLERK OF THE BOARD
FROM: Terri Ysaguirre
SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 8/24/2020
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.
#75 Morristown Elementary Xavier G Bedolla $1,454.49
RECEIVED -T35""
AUG 28 2020
MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS
Application for a Duplicate or Stale-Dated Warrant/ Check
Affidavit/ Claim Form
This application is for: =| Duplicate or C1 stale-Dated (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.
Xavier G Bedolla (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about August 18, 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 $ 1,454.49 (3)
Signed: **See attached** ta)
Print name: (required) Xavier G Bedolla
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
(5) Subscribed and sworn to before me this day of 20
NOTARY PUBLIC
. ; **See attached**
My commission expires:
(seal)
Warrant/Check Number 3700345180
(if known) (6)
Original Date of Issue
(if known) (7) August 18, 2020
Reason for original issue of Warrant/Check (8):
Payroll
OO For Services or Goods furnished L_
O Treasurer's refund/payment
O Other:
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Current Claim Form\100518 Warrants Checks notice of claim.doc
Revised 100518 A.R.S. 11-632 & 11-644
LOST CHECK AFFIDAVIT
MORRISTOWN ELEMENTARY
SCHOOL DISTRICT NO.75
|, Kaveel G. Bade lo , being first duly sworn, do depose and say that | am Xavier G.
Bedolla, the entity named as the payee of the warrant number 3700345180, drawn by
the Treasurer of Maricopa County on August 18, 2020 for the sum of $1,454.49.
Being still sworn, | further say that the above described check has not been received or
negotiated by me. The above described check has been lost, and, by this affidavit, | am
requesting that the Nadaburg USD, County of Maricopa County place a stop payment
on the above-described check and issue a replacement check.
| understand that under no circumstances should | present the above-described check
for payment if it should come into my possession after the filing of this affidavit, and |
hereby indemnify and hold harmless the Nadaburg School District form any liability,
loss, expense, or damage which may occur as a result of the issuance of the original
check and/or the replacement check.
Affiant’s Signature Jer bo aa
Sworn to and subscribed before me thie” day of hug ack 2050.
Notary Public in and for ly Commission expire: .
u TRICIA DAWN FARRINGTON :
| v NCA CoN ©. XN ecm kos Notary Public - State of Adzone | \_
~ Jy ={ [ise] If MARICOPA COUNTY
Qo
Commission # 550628
Expires August 03, 2022
Return ORIGINAL NOTARIZED FORM to: For questions, contact:
Morristown Elementary School District #75 Jen Carlson
Business Services
PO Box 98
Morristown, AZ 85342 (623) 388-21 33
jcarlson@morristowneld75.org