VASQUEZ.PDF

Maricopa County — Formal (2020-08-19)

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INTEROFFICE MEMORANDUM

Maricopa County Schools Superintendent Office

TO: CLERK OF THE BOARD

FROM: Terri Ysaguirre

SUBJECT: Affidavits —- Replacement of Lost Warrants
DATE: 7/23/2020

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.

v 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 Patricia Anna Vasquez $5,513.76

DS.
Tlomaw

RECEIVED ~

JUL 24 2020

MAF! COUNTY
CLERK BOARD OF SUPERVISORS

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.
Patricia Vasquez (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about @ i 20] AOXO (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 a ount shown is due and owing, and the applicant requests that a replacement

$9,513.76 (3)

warrant/check be issued ie in the sum of

Signed: __ niten| Ulu (4)
di l LK

(5) Subscribed and sworn td before me this 2.2._day of July 2020 _.
NOTARY PUBLIC
Brittany Carter

Notary Public
Maricopa County, Arizona
My Commission Expires

April 30, 2023 (seal)
Commission No, 562528

My commission expires:
Aoril 36, 2093
LU

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 |3799329546

(if known) (6)

Original Date of Issue 06/30/2020

(if known) (7)

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

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