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INTEROFFICE MEMORANDUM
Maricopa C County Schools Superintendent Office
RECEIVED ci
TO: CLERK OF THE BOARD
JUN 802020“
FROM: Terri Ysaguirre
MARICOPA COUNTY
SUBJECT: Affidavits — Replacement of Lost Warrants CLERK BOARD OF SUPERVISORS
DATE: 6/29/2020
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.
#66 Roosevelt Elementary Lobel Financial Corp $643.44
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.
Lobel aS Corp (1), being first sworn, upon oath deposes and says:
ame/Claiman
On or about 12/03/2019 (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 $ 643.44 (3)
Signed: Nar as MaLha (4)
(5) Ty. and sworn_to before me this _2U a day of _s [ LAO 2020.
nr &
NOTARY PUBLIC
DONNA R CUMMINGS
Notary Public - Arizona
Maricopa County
Commission # 552361
My commission expires:
1O~\$-20aR (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 3700255716
(if known) (6)
Original Date of Issue 12/03/2019
(if known) (7)
Reason for original issue of Warrant/Check (8):
O Payroll APPROVED
, F DATE _-*7 ‘ ry)
1 For Services or Goods furnished { tf2n20
Other: FRAN McCARROII
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
Seidberg Law Offices PC
P.O. Box 7290
Phoenix, AZ 85011-7290
602-248-8117 ext. 216
June 24, 2020
Office of The Maricopa County School Superintendent
Attn: Finance Desk
4041 N. Central Ave. Ste. 1200
Phoenix, AZ 85012
RE: Affidavit
Hello,
Iam confirming that Nancy Mathews, signer of the affidavit, is authorized to sign for
Seidberg Law Offices. Please let us know if there is anything further needed.
Vv
~ Kenneth\W Seidberg
Attorney for the Firm