Extracted text (via ocr_local)
2626 characters
INTEROFFICE MEMORANDUM
Maricopa County Schools St Superintendent Office
RECEIVED veoh,
TO: CLERK OF THE BOARD
14 2020
FROM: Terri Ysaguirre JUL 4 :
a MARICOPA COUNTY
SUBJECT: Affidavits — Replacement of Lost Warrants CLERK BOARD OF SUPERVISORS
DATE: 7/9/2020
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.
#79 Litchfield Elementary Brittany Peters $504.51
Se
ih i
SaeG
Couns
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.
Brittany, Peters (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 5/12/2020 (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 ¢904.51 (3)
Signed:. DMLLZL LEN { Ee (4)
rd Subscribe and sworn to before me this__\°" day of _J Uy 202° ,
NOTARY PUBLIC
Linda Buswell
Notary Public
Maricopa County, Arizona
My Comm. Expires 02-10-23
Commission No. 560963
My commission expires:
5/12/2020
(seal)
Note. Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
Warrant/Check Number 3700312431
(if known) (6)
Original Date of Issue 05/12/2020
(if. known) (7)
Reason for original issue of Warrant/Check (8): AT JUL 17 2020
@ Payroll Ce,
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