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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: 6/8/2020 Please find attached 1 Affidavit/Notice of Claim(s) for lost warrants for inclusion on the next available Board agenda V 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 terrLysaguirre@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. #59 Laveen Elementary Jeremy CaIles $5,000.00 co,0 RECEIVED ov-iLs- eivc-t\ JUN 0 9 2020 MARICOPA COUNTY CLERK BOARD OF SUPERVISORS (seal) JOYCE C. COUNCIL Notary Public State of Arizona MARICOPA COUNTY My Commission Expires September 11, 2021 My commission expires: yruil //, a?a?/ K r OTOKR 0-OF SUPERVISORS NIA7,C0';\ OCL:NTY Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: Duplicate or 0 Stale-Dated (definitions are on page 2) STATE OF ARIZONA COUNTY OF MARICOPA Note: Numbers on this form correspond to numbers on the Instruction sheet which is page 2 of this form. Jeremy CaIles Name/Claimant On or about March 26, 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 $ Five Thousand and no/100 dollares . (3) Signed: (4) Note: vPlease attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. (5) Subscribed and sworn to before rneThis /.5'614- day of _ 6Lia4tel NOTARY P BLIC 20,22,5 (1), being first sworn, upon oath deposes and says: Warrant/Check Number (if known) (6) 3700298360 Original Date of Issue (if known) (7) 3/26/2020 Reason for original issue of Warrant/Check (8): El Payroll For Services or Goods furnished El Treasurer's refund/payment LI Other: S: \ PROCESSES \Warrants - Duplicate or Stale \ 02 Forms\Warrants Checks notice of claim - Copy.doc Revised April 2015 A.R.S. 11-632 & 11-644 May 15, 2020 Laveen Elementary School District Attention: Sally Perschbacher 5001 W Dobbins Road Laveen, AZ 85339 Dear Ms. Perschbacher, It has come to my attention that the check that was originally mailed to me on 3/30/20 was sent to an old address and as of this date it has not been forwarded by the Post Office. If you can send me a replacement check to my new address which you have confirmed is now updated in your system then I would appreciate it. Thank you. Warrant Number - 3700298360 Status Issued Account # Paid Date Issued Date Registered Date Payee Amount Interest Claim # Sub Fund Dept # PO # LowOrig Voucher 03/26/2020 Jeremy CaIles $5000.00 2173 DashBoard Page 1 of 1 https://treasurer.maricopa.gov/Agency Web/Dashboard 6/1/2020