JAMIE GLEN.PDF

Maricopa County — Formal (2020-02-12)

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REr- 
JAN 17 
Clr0ARD OF SUPERVISORS-- 
INTEROFFICE MEMORANDUM 
 
_ 
Maricopa County Schools Superintendent Office 
TO: 	
CLERK OF THE BOARD 
FROM: 	
Terri Ysaguirre 
SUBJECT: Affidavits — Replacement of Lost Warrants 
DATE: 	
1/15/2020 
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. 
#95 	 Queen Creek Unified 	Jamie Glen 	
$925.39

warrant/check be issged to him/her in the sum of $ 	
.(3) 
Signed! 
(5) Subscr, 
(4) 
end swoiAto before me this 	
cii " day of  DectrAeAr  20 I 
 . 
NOTARY PU 
My commission expires: 
3 —2.cre.1 
JENNIFER GIANZERO 
NotaryPublk-StstsolArtans 
PINALCOUNTY 
My Commission Ervin 
August03, 2021 oe 
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. 
Name/Claimant 
On or about 	
tol \ k°1 	 (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 
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) 
3-1(.1)13L-1 to73 
Original Date of Issue 
(if known) (7) 
\ '`.1 VI 
(1), being first sworn, upon oath deposes and says: 
Re7n for original issue of Warrant/Check (8): 
Payroll 
El For Services or Goods furnished 
CI Other; 
DATE 
N_2 3_202 
.41111111te; 	
ii 
 
1?-7-, 	 ar tr•-• 
— • 
MARICOPA COUNTY 
SAPROCESSES\Warrants - Duplicate or Stale \02 Forms\Schools\5chools-Warrants Checks notice of claim.doc 
Revised June 2015 	
A.R.S, 11-632 & 15-999