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INTEROFFICE MEMORANDUM
Maricopa County Schools Superintendent Office
A\ YN
RECEIVED ose
TO: CLERK OF THE BOARD N
FROM: Terri Ysaguirre JUL 14 2020
SUBJECT: Affidavits — Replacement of Lost Warrants CLERK BOARD OF SU SOR
DATE: 7/13/2020
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.
#66 Roosevelt Elementary Collections USA, Inc $102.77
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.
COLLECTIONS USA, INC. (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 11/19/2019 (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 —— g 102.77 (3)
Signed: a —= (4)
(5) Subscribed and sworn to before me this (ttt day of { LU 2020.
Linh ttfacre-
‘NOTARY, PUBLIC | U J
My commission, expires:
surononyy [Ul 24,2020
DARLENE K. K. JACOB
NOTARY PUBLIC » ARIZONA
eae COUNTY
y Commission Expires
July 29, 2020 (seal)
Note, Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
(if known) (6)
Warrant/Check Number 3700250476 Von Ad
id 6
Original Date of I
riginal Date of Issue | 44/19/2019 Pet
Reason for original issue of Warrant/Check (8):
O Payroll
C For Services or Goods furnished Vendor did not receive check
Other: Vendor did not receive check
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
OLLECTIONS
SA INC.
“Collection Specialists” 21640 N 19™ AVE #C-3
Phoenix, AZ 85027
(623) 581-2433
(800) 743-0434 toll free
July 1, 2020
Elizabeth Bernal
Roosevelt School District
6000 S. 7" Street
Phoenix, AZ 85042
Ms. Bernal,
This letter is to confirm that Ed Bramel, President of Collections USA, Inc., is an
authorized signer on the bank accounts.
Collections U.S.A., Inc.
This communication is from a debt collector and is an attempt to collect a debt. Any information
obtained will be used for that purpose.