Extracted text (via ocr_local)
2462 characters
INTEROFFICE MEMORANDUM Maricopa County Schools Superintendent Office TO: CLERK OF THE BOARD FROM: | Terri Ysaguirre SUBJECT: Affidavits — Replacement of Lost Warrants DATE: 6/9/2020 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. #95 Queen Creek Unified Kimberly Russell $150.00 Schools Affidiavit/ Clairn Form STATE OF ARIZONA E Numbers on this form correspond to numbers on the Application for a Duplicate Warrant/Check (definitions are on page 2) COUNTY OF MARICOPA Instruction sheet which is page 2 of this form. i . _ aa medal ASK. | (1), being first sworn, upon oath deposes and says: Yame/Clairnant v On or about $Y (2009_ (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 cate 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 4150-00. warrant/cl eck be issued to Peal of $ uA (3) seneasLCnbaley of —_.__(4) yy — (5) Subscribed and sworn to before me this \ day of Dene 2020 , = NOTARY PUBLIC ZACK CRAIN Notary Public - Arizona My cgminjssion expires: ler eYfOF 3 My Comm. Expires 04/09/2023 (seal) Note, Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued, Sasi Teal BBL & O48. 5 a ‘iginal jp / © Origina eae 7 S/H Ula O Reason for original issue of Warrant/Check (8): C1 Payroll CJ For Services or Goods furnished__ yA other: LOST CHECK. - Pe fund. S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schouls-Warrants Checks notice of clairn.doc Revised June 2015 ARS. 11-632 & 15-999