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RECEIVED JAN .1 7 2020 MARICORA COUNTY --CLZRK-BOAFID,OFSUPERVISORS' INTEROFFICE MEMORANDUM Maricopa County Schools Superintendent Office TO: CLERK OF THE BOARD FROM: Terri Ysaguirre SUBJECT: Affidavits — Replacement of Lost Warrants DATE: 1/16/2020 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. #402 West-MEC Agua Fria UHSD-CTE $512,751.54 _ SAPROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of clairn.doc Revised June 2015 A.R.S. 11-632 lk 15-999 DEC 1 2 2019 uL Schools Affidavit! Claim Form Application for a Duplicate Warrant/Check (definitions are on page 2) STATE OF ARIZONA COUNTY OF MARICOPA Nam aimant gCk.c. U WV\-- CI 0, being first sworn, upon oath deposes and says: On or about ).---ka.0\ czcg (N (date)(2) a warrant/check was issued to the above named persori/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 \ • .(3) Signed: C:`1---(--1- 'scribed and svvor to before me this 1 0 day of IDCCehlbtr 20 19 . Note: Numbers on this form correspond to numbers on the Instruction sheet which Is page 2 of this form. •(4) (seal) 421rARY PUBLIC My commission expires: CHELSEA HELENA Mitt Notary Public - Arizona MARICOPA COUNTY Commission # 569609 Expires August 6, 2023 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) Original Date of Issue (If known) (7) C) 1 D S? i9t) I ci Reason for original issue of Warrant/Check (8): 0 Payroll I:1 For Services or Goods furnished 511, Other: Sincerely, Marcie Rodriguez Exec. Director of Business Services GOVERNING BOARD Mrs. Gina DeCoste Ms. Maxine Hill Mrs. Vickie Landis Mrs. Mariana Sandoval Mrs. Mary Kay Utecht ADMINISTRATION Dr. Dennis Runyan Superintendent Mr. Thomas Huffman Executive Director of Educational Services 1481 N. Eliseo Felix Jr. Way, Suite 110, Avondale, AZ 85323 • VOICE (623) 932-7000 • FAX (623) 932-2796 January 15, 2020 To: Maricopa County Superintendent Re: Statement Letter for lost check We here at the Business Services Department at Agua Fria Unified School District did not receive the WestMEC Warrant/check number 3700176462, original date of issue 05/08/2019. The Affidavit was signed by Quay Bolton-Lattari an authorized signer. If you have any questions feel free to contact me.