YOUNG.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: 	
3/23/2020 
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.ysaguirre@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. 
#216 	Agua Fria Union 	
Rodney Young Sr 	
$713.28 
RECEIVED 
 • - •h-14vzI 
MAR 24 2020 
MAR1COPA COUNTY 
CLERK BOARD OF SUPERVISORS

(seal) 
NOTARY PUBLIC 
My commission expires: 
4Z/7 //L/r,Z 
ANNA YOUNG 
Notary Public. State of Arizona 
MARICOPA COUNTY 
My Commission Expires 
January 14, 2022 
Reason for original issue of Warrant/Check (8): 
Payroll 
1:1 For Services or Goods furnished 	
Nse-r vciv 
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 page 2 of this form. 
Rodney Young, Sr. 
(1), being first sworn, upon oath deposes and says: 
Name/Claimant 
On or about 	
a-Da-C) 
	
(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 $713.28 	
.(3) 
Signed: 	 
V(9U' r\)C)
SQ- 
(4) 
(5) Subscribed and sworn to before me this  a 
 day of 	
r10/ 
 2(We 
441-1 	
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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) 
216734016/3700294242 
Original Date of Issue 
(if known) (7) 
3-17-2020 
CI Other: 	
 
S:\PROCESSES\Warrants- Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of clalm.doc 
Revised June 2015 	
A.R.S, 11-632 & 15-999