SMITH.PDF

Maricopa County — Formal (2020-04-08)

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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: 	
3/19/2020 
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 	
Eric B Smith 	
$1,130.83 
RECEIVED 
MAR 2 0 2020 
MARICOPA COUNTY 
CLERK BOARD OF SUPERVISORS

Dulce A Martinez 
Notary Public - Arizona 
Maricopa County 
My Comm. Expires 02-27-23 
My commission expires: 
Warrant/Check Number 
(if known) (6)  
Original Date of Issue 
(if known) (7)  
3700285454 
2/25/2020 
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 	Note: Numbers on this form correspond to numbers on the 
COUNTY OF MARICOPA 	
Instruction sheet which is page 2 of this form. 
SMITH, ERIC B. 
Name/Claimant 
On or about 2/25/2020
(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 i sued to him/her in the su of $1 130.83 
Signed: 	
 
Note: Please attach a copy of the warrant/check if available and/or any other 
evidence that a warrant/check was originally issued. 
( ) at scr ed and sworn t befor me this  I-WI 
 day of  000(ch 
	20 20 . 
( 
tiLL  
NOTARY PUBLIC 
(1), being first sworn, upon oath deposes and says: 
.(3) 
(4) 
(seal) 
Reason for original issue of Warrant/Check (8): 
Payroll 
III For Services or Goods furnished 
0 Treasurer's refund/payment 
111 Other: 	
 
S: \ PROCESSES \Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc 
Revised April 2015 
A.R.S. 11-632 & 11-694