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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:
2/21/2020
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.
#65 Littleton Elementary
Maria G Serrano $352.97
Warrant/Check Number
If known) (6
Original Date of Issue
If known) (7
Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: ErDuplicate 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.
n Se
C) (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about
11
( .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, 21: 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 $
/14A /(a9
(4)
Note: Please attach a copy of the wairanVcheck if available and/or any other
evidence that a warrant/check was ofiginally issued.
.(3)
My commission expires:
('
(5) Subscribed and sworn
0 ARY PUBLIC
before me this 7 0 day of Ce bri-, 20
ANAMARIA QUIIVTANILLA
Moiety Public - State of Arizona
MAR ICOPA COUNTY
Commission #
Expires May 1:,t114)
)
7 to £9
5 2:01,p
Reason for original issue of Warrant/Check (8):
`Payroll
O For Services or Goods furnished
O Treasurer's refund/payment
O Other:
DATE
S:\PROCESSES\Warrants - Duplicate or Stale \02 Forms\Warrants Checks notice of claim - Copy.doc
Revised April 2015
A.R.S. 11-632 & 11-644
MARICOPA COUNTY SCHOOL SUPERINTE NDENt
4041 N COMM, Stilte 1100
PHOENIX AZ 85012
TO: PAYROLL ACCOUNTS PAYABLE
PLEASE STOP PAYMENT AND REISSUE THE FOLLOWING WARRANT:
DISTRICT NUMBER:
PERSON REQUESTING
REQUESTING I
STOP PAYMENT:
Cr PHONE illillaxT;
WARRANT NUMBER:
3 7
R22(-0/0 WARRANT DATE: ---)9/ 7 ic-pa
(prefix)
(number)
(mm)
(dd)
(yy)
PAYABLE TO:
2
1/71" er
je
AMOUNT:
97
FUND NO: (212 VOUCHER NO:
CHECK ONE: EXPENSE
PAYROLL
REASON FOR STOP:
4.4.•
(LOST, DESTROYED, ETC.)
ONE ORIGINAL AFFIDAVIT AND ONE COPY OF THE AFFIDAVIT ARE ATTACHED. PLEASE
ISSUE A REPLACEMENT WARRANT.
(FOR COUNTY USE ONLY)
STATUS VERIFIED:
$70P DATE;
REPLACED:
STOP VERIFIED:
WARRANT #:
AFFIDAVIT SENT:
AFFIDAVIT APPROVED:
RECONS RETURNED: STOP PREPAID
Revised NSW
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