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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: 4/6/2020 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 terriNsaguirre@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. #17 Tolleson Elementary Ivan Gastelum $1,188.08 REC D APR 14 2020 marvcopiet 0°u/qv CLERK BOARD OF- SUPRVISORS (seal) ?I/A NOTAR PUBLIC My cpmr9ission expires: CATHEY L MAYES Wary Pubic Salta diatom 1AARICOPACOUNTI My CommIsaloa Ex** March 15,2021 Schools Affidavit/Claim Form Application for a Duplicate Warrant/Check (definitions are on page 2) STATE OF ARIZONA COUNTY OF MARICOPA IVRIV ct.-t-c, Iut-m (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 3 1 20 (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 $ \ og Signed: _J_ C4 (5) Subscribed and sworn to before me this 42- rk day of a.pn..4.1: 20 2 . Note: Numbers on this form correspond to numbers on the Instruction sheet which is page 2 of this form. .(3) (4) 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) 39COAci 1 4q I Original Date of Issue (if known) (7) 0 3I2i I aoar3 Reason for original issue of Warrant/Check (8): cif Payroll 0 For Services or Goods furnished 0 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