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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: -71,e.4--e_•sc). \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 • q....V-Aritt_m0.--A.4.6,T&•%-' • 7,, 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 "= My Comm. Exp. Sep.23, 2021 _F- iiiiiiiiiiniriniIIIiiiiiiiiiiiiininiiiiinninniiiminiiiiiiniiiiimintiii Subscribed and sworn to (or affirmed) before me L'- on this day of Date (1) (he/e_601 kaq (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 .14-/ /1,-- #PcIv'ilc/. :, 4 / -br J / ,, „I ,-- ,..i ,- (-- j02___ ki,iff-4, - c Title or Type of Document: d'y 4 , a 1 f e''' ;74 f miocument Date: Number of Pages: 3, Signer(s) Other Than Named Above: .97-• ET W• , -0,4 ©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