OLYMPIUS.PDF

Maricopa County — Formal (2020-08-19)

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INTEROFFICE MEMORANDUM

Maricopa ‘County Schools Superintendent Office

RECEIVED

TO: CLERK OF THE BOARD & ely

FROM: _ Terri Ysaguirre JUL 14 2020 Jy
PA)

SUBJECT: Affidavits — Replacement of Lost Warrants SEERK OED > GLRER SORE v

DATE: 7/9/2020

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.

#79 Litchfield Elementary Donna Carol Olympius $1,664.23

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.
Donna Olympius (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about AE Lor (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 nine in the sum of $ 1,664.23 (3)
yy, ; . Fo ~ /\ -
Signed: __- Cénz ZG. é Lee ip GED (4)

(5) Subscribed and sworn to before me this__ __day of July 2020 |
) fy Lf.
NOTARY PUBLIC a

Notary Public

> Maricopa County, Arizona

My Commission Expires
April 30, 2023

Commission No. 562528 (seal)

My commission expires:
Aon | 30, 2023

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 3700215038

(if known) (6)

Original Date of Issue 08/20/2019 — AP =

(if. known) (7)

Reason for original issue of Warrant/Check (8): DATEg __ JUL 7 2020
@ Payroll | AL, od

C1 For Services or Goods furnished
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