FELIX REDACT.PDF

Maricopa County — Formal (2020-06-24)

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JUN 0 9 2020 
MARICOPA COUNTY 
CLERK BOARD OF SUPERVISORS 
RECEIVED 
ovy,,AA 
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 
terri.vsaguirre@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. 
#44 	
Avondale Elementary 	
Brisiera Felix 	
$267.96

n to kgfore me this  2'14  day of  kAM_ 	20 90 
Duice A Martinez 
Notary Public - Arizona 
Maricopa County 
My Comm. Expires 02-27-23 
Commission No. 569157 
(seal) 
Signed: 
(4) 
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. 
Briseira Felix 
Name/Claimant 
On or about
il/111:2 b:2 0 	
(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/c,441issued to him/her in the sum of $267.96 	
.(3) 
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 
(if known) (6) 
3700306510 
.4-41 	
,,-' 
 
e i. 
Original Date of Issue 
04/17/2020 
 
DATE 
Reason for original issue of Warrant/Check (8): 
El Payroll 
El For Services or Goods furnished  Preschool School Program Refund  
Other: Preschool School Program Refund 
S:\PROCESSES\Warrants  - Duplicate or Stale\02 Fornns\Schools\Schools-Warrants Checks notice of claim.doc 
Revised June 2015 	
A.R.S. 11-632 & 15-999 
(1), being first sworn, upon oath deposes and says: 
D-0 F—SLJPE-R 
MARICOPA COUNTY