VIDCODE.PDF

Maricopa County — Formal (2020-02-12)

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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: 	
1/27/2020 
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. 
#216 	
Agua Fria Union 	
Vidcode 	
$2,900.00 
#5 	
Isaac Elementary 	 Johel Gonzales Salomon 	
$917.27 
RECEIVED 
JAN 2 9 2020 
• MARICOPA COUNTY 
CLERK BOARD OF SUPERVISORS

Application for a Duplicate or Stale-Dated Warrant/Check 
Affidavit/Claim Form 
This application is for: • Duplicate or El Stale -Dated (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. 
Vidcode 
Name/Claimant 
On or about  August 6, 2019 	
(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)s§ued to him/her in the sum of $  2,900.00 
 
Signed: 	
 
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\L....Z-3 0-r\ 
Note: Please attach a copy of the warrant/check if available and/or any other 
evidence that a warrant/check was originally issued. 
(5) Subscribed and sworn to before me this 	day of 
20 	
. 
NOTARY PUBLIC 
My commission expires: 
(seal) 
Warrant/Check Number 
(if known) (6)  
Original Date of Issue 
(if known) (7)  
3700211105 
August 6, 2019 
Ap
-gk6 vr  
(1), being first sworn, upon oath deposes and says: 
/\ 5 / 2.02 0 (4) 
.(3) 
Reason for original issue of Warrant/Check (8): 
CI Payroll 
4101111.V _ . 41.14 
For Services or Goods furnished  7/24/19 	
•11:45- 	
- YI 
MARICOPA COUNTY  
U E 
El Treasurer's refund/payment 	
 
ID Other: 	
 
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc 
Revised April 2015 
A.R.S. 11-632 & 11-644

proved to me on the basis of satisfactory evidence 
to be the person(s) whVappeared before me. 
I 
Signature 
A FORMA JUIRAT WIITh AL HT ST TIMENT 
G VER KENT CODE § 8202 
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V See Attached Document (Notary to cross out lines 1-6 below) 
0 See Statement Below (Lines 1-6 to be completed only by document signer[s], not Notary) 
Signature of Document Signer No. 1 	
Signature of Document Signer No. 2 pc any) 
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the 
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. 
State of CalifoTia 
County of 	
Ain 	
ri 
N11111111111111111011111111111111111111111111111111111111111111111111111111111111111111112 
ATIEH RAMEZANI 
COMM. #2215599 
NOTARY PUBLIC-CALIFORNIA 1,1 
SANTA CLARA COUNTY 	
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My Comm. Exp. Sep.23, 2021 _F-
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Subscribed and sworn to (or affirmed) before me 
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on this 	
 day of 	
 
Date 
(1)  (he/e_601 	
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(and (2) 	
 ), 
ame s of Signer(s) 
_for 	
, 20 02-0 , 
Month 	Year 
Seal 
Place Notaiy Seal Above 
OPT§ * N L 
• Though this section is optional, completing this information can deter alteration of the document or 
fraudulent reattachment of this form to an unintended document. 
Description of 4 ttached Document 	
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Title or Type of Document: 
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Number of Pages: 3,  Signer(s) Other Than Named Above: 	
 
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©2014 National Notary Association wvvw.NationalNotary.org 1-800-US NOTARY (1-800-876-6827) Item #5910

195 Montague St. 
Floor 14 
Brooklyn, NY 11201 
:).ECEib 
• -. JAN 2 2 . 2020 . h 
u 
-13Y: 	
' 
Re: Vidcode Inc. - Authorization Letter 
iiiP vidoode 
To Whom It May Concern: 
This letter is written to confirm that as of 1/7/2020, Vicicode Inc. has not yet received a check in 
the amount of $2,900 from Agua Fria Union School District. 
Please see enclosed notarized Affidavit/Claim Form signed by Theresa Kwan, an authorized 
signer for Vidcode. 
If you have any questions, please feel free to contact me at (612) 578-1499 or 
allie@vidcode.com . 
Sincerely, 
Alexandra Diracles 
CEO