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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: 7/30/2020
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.
#25 Liberty Elementary Maria Valenzuela $535.00
Zia weve"
RECEIVED *5."
AUG 03 2020
Coantd
WARICOPA ,
Mi VienviGORS
CLERK BOARD O
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.
Maria Valenzuela (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about won 23,2020 (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 $935.00 (3)
signet LY [arte rs Uabpuabe (4)
(5) Subscribed and sworn to before me this od ‘| \day of _ JU Lif 20 20.
NOTARY PUBLIC S Diana Carlos
Notary Public
. . . Maricopa County, Arizona
My commission expires: My Comm. Expires 04-12-2022
oY { 2/2022. "Commission # 646166 (seal)
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
Wi Check b
re com). * [3700328890 <5. AUG 0 4 2020
Original Date of I -
Final Date of Issue | June 23, 2020
Reason for original issue of Warrant/Check (8):
OO Payroll
C For Services or Goods furnished Refund for Field Trip Cancellation - Covid-19
jl Other: Refund for Field Trip Cancellation - Covid-19
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