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RECEIVEDO 0-S JAN 1 4 2020 INTEROFFICE MEMORANDUM CLERK BOARD OF SUPERVISORS Maricopa County Schools Superintendent Office TO: CLERK OF THE BOARD FROM: Terri Ysaguirre SUBJECT: Affidavits — Replacement of Lost Warrants DATE: 1/13/2020 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. #214 Tolleson Union Notary Bond Agency $55.00 #95 Queen Creek Unified Donald Kramer $319.37 CHRISTINE S. CORNELIUS Notary Public- State of Arizona MARICOPA COUNTY My Commission Expires Dec. 26,2021 My commission expires: Schools 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. Notary Bond Agency Name/Claimant On or about October 29, 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 issued to hi /her in the sum of $ 55 .00 .(3) Signe (4) (5) Subscribed and sworn to before me this af/k day oC, U/2*/' 20 19 . (1), being first sworn, upon oath deposes and says: (seal) 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) 3700244321 / 214762242 Original Date of Issue (if known) (7) 10/29/19 .e. I,P P Reason for original issue of Warrant/Check (8): El Payroll gl For Services or Goods furnished 111 Other: S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools \Schools-Warrants Checks notice of claim.doc Revised June 2015 A.R.S. 11-632 & 15-999 January 10, 2020 Notary Bond Your LOCO' Independent Agency Agency To: Maricopa County/Tolleson Union High School District RE: Lost Check Affidavit #214 for bond LSM1302367 Please be advised that our company has no record of receiving check number 3700244321/214762242. Your records should show that the check was not cashed as well. Kandace Norris who signed the affidavit does have authority to sign the affidavit on behalf of Notary Bond Agency. Should you need anything further please let me know. Kind Regards, Christine S. Cornelius, Director Underwriting 16165 N 83 rd Ave Ste 201 • Peoria, Arizona 85382 PHONE 623.412.428 ,1 11)1,...L. FREE: 800.491,5913 FAX: 8136.9642382 www.notarybondaciency.com