JOHEL SALOMON.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 
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 21)20 
MARICOFA COUNTY 
CLERK BOARD OF SUPERVISORS

6sT-7' 
My commit ion 
91 0 
Piri-gHZ-
: 
 
(5) Subscrib+ 
• 	
 
NOTARY PUBLIC 
and sworn to before mes 	
1 Li.. day of 
: 
. SANDRA APONTE 
NotIjyPublic.$tutBaqMzona 
MARICOPA COUNTY 
My Comm. ExpirosApifl 11,2020 	
(seal) 
20 
Reason for original issue-of Warrant/Check (8): 
,Payroll 
0 For Services or Goods furnished 
DATE 
AN1311020 
ent:wo 
0 Other: 	
 
SchoE Is Affidavit/Claim Form 
Application for a Duplicate Warrant/Check (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. 
jQnklegim0Onta kS EdOillort  (1), being first sworn, upon oath deposes and says: 
On or about  al hp 120Z-0 . ( 
Jlate) (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 issued to him/her in the sum of $ 
Signed: 
	
(4) 
Note: Please attach a copy of the warrant/check if available and/or any other 
evidenee that a warrant/check was originally issued,. 
Warrant/Check Number 
Original Date of Issue 
. 	
. 	
(if known) (7) 
 
......._ 	
_ 
S: \PROCESSES \Warrants - DuplicaCeor Stale \02 Forms \Schools \Schools-Warrants Checks . notice.ofclaindoc 
Revised June 2015 	
A.R.S. 11-632 & 15-999