REYNOSO.PDF

Maricopa County — Formal (2020-08-19)

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TO: CLERK OF THE BOARD JUL 1-4 2020 x \
FROM: _ Terri Ysaguirre MARICOPA COUNTY

CLERK BOARD OF SUPERVISORS
SUBJECT: Affidavits — Replacement of Lost Warrants
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.

#60 Higley Unified Jessica Reynoso $400.00

Schools Affidavit/Claim Form

Application fora 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.
Jessica Reynoso (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about 6/18/2020 (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 ¢ 400.00 (3)

Signed: Aes Bin Pencrs (4)
(

(5) Subscribed and sworn to before me this gtA day of July 20_2-0.

Winer a

NOTARY PUBLIC ~ ‘= — aa Sea ]

» JANE K BOSTON

My commission EXPITES> Aw,

Come, #558063 Exp, Nov. 5, 2vz2l (seal)

perenne tant ey Tent ae ae en enn

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 | 3799398467

(if known) (6)

Original Date of Issue 06/18/2020 ee

(if known) (7)

Reason for original issue of Warrant/Check (8):
OO Payroll

O For Services or Goods furnished
Other: reimbursement for child care

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

Date: ‘71 | § 120

To whom it may concern:
The check listed in the attached documents was not received in the mail please reissue.

Thank you

jerren

JESSICA Rey NOSO