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INTEROFFICE MEMORANDUM Maricopa County Schools Superintendent Office cn RECENED atthe TO: CLERK OF THE BOARD nua 18 2028 ror FROM: Terri Ysaguirre aOQUNTY MARIC OPA CO NpERVISORS SUBJECT: Affidavits — Replacement of Lost Warrants CLERK BOARD DATE: 8/17/2020 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. 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. #60 Higley Unified Wist $813.93 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. Wist (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 12/11/2019 (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 $813.93 3) Signed: f (4) __\\ (5) Subscribed and sworn to before me this _\‘!_day of PUGUS) 20.90 . NOTARY PUBLIC U NINA A. SCALZO My commission expires: NOMTARIGOPAGOUNTY \ i a 2033 Expires November? 2028 (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 3700260937 (if known) (6) Original Date of Issue yy) (if known) (7) 1 2/1 1/1 9 aa Reason for original issue of Warrant/Check (8): OO Payroll For Services or Goods furnished Office supplies O 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 “WwisT Business Supplies & Equipment ave 2 1 2020 ices August 7, 2020 Fi nancial Servic To Whom It May Concern: A check from Higley Unified School District was lost in the mail. Please see the enclosed for the signed affidavit. Peter Drozdowicz is authorized to sign this affidavit for Wist Supply & Equipment. MARICOPA COUNTY SCHOOL SUPERINTENDENT 4041 N Central, Suite 1100 PHOENIX, AZ 85012 TO: PAYROLL — ACCOUNTS PAYABLE PLEASE STOP PAYMENT AND REISSUE THE FOLLOWING WARRANT: DISTRICT NUMBER: lic STOP PAYMENT: iS! EATIE PHONE #( +) 279 -7043 ext: WARRANT NUMBER: _ 277 - O02. (0°37 WARRANT DATE: Say MAD (prefix) (number) (mm) (dd) (yy) PAYABLE TO: Wist AMOUNT: $15-93 FUND NO: Co | VOUCHER NGS es CHECK ONE: EXPENSE PAYROLL K REASON FOR STOP: . Check. Lost im Maic~ PLEASE REISS0F (LOST, DESTROYED, ETC.) ONE ORIGINAL AFFIDAVIT AND ONE COPY OF THE AFFIDAVIT ARE ATTACHED. PLEASE ISSUE A REPLACEMENT WARRANT. (FOR COUNTY USE ONLY) STATUS VERIFIED: STOP DATE: REPLACED: STOP VERIFIED: WARRANT #: AFFIDAVIT SENT: AFFIDAVIT APPROVED: RECONS RETURNED: STOP PREPAID Revised 4/5/07 \\Mcss_411\data\Repository\Share\PayRoll\Front Desk (finance) sample memos, etc\LOST WARRANT STOP-REISSUE COVER SHEET.doc