TOLLIVER.PDF

Maricopa County — Formal (2020-06-10)

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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: 	
5/22/2020 
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. 
#79 	
Litchfield Elementary 	
Tara Jane Thorbin-Tolliver 	 $549.30 
RECEIVED 
MAY 2 6 2020 
MARICOPA COUNTY 
CLERK BOARD OF SUPERVISORS

warratsheck be issued 
i her in he sutp-ef—s,, 5-9 d7 3) 
 
.(3) 
(4) 
MAY 2 7 2020 
Schools Affidavit/Claim Form 
Application for a Duplicate Warrant/Check (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 pa ge 2 of this form. 
(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 
GAgCtrie. I hoth'in--P ve( 
	(1), being first sworn, upon oath deposes and says: 
Name/ aimant 
On or about 	
111;W 
(5) Subscribed and sworn to before me this   I3 
	day of  1nex.,1 
 
NOTARY PUBLIC 
My commission expires: 
jC)a  
Brittany Carter 
Notary Public 
Maricopa County, Arizona 
My Commission Expires 
April 30, 2023 
Commission No, 662528 	(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 
(if known) (6) 
3 -70o .6,;z:). -q8/6(4. 79 73"/218 
Original Date of Issue 
(if known) (7) 
V/ 
 
Respn for original issue of Warrant/Check (8): 
^.Payroll 
111 For Services or Goods furnished 
LI 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