PAYAN.PDF

Maricopa County — Formal (2020-01-29)

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RECEIVED -wlv` 
JAN -72020 
MAFIICOF*GOUNTY - -- 
CLERK BOARD OF SUPERVISORS 
INTEROFFICE MEMORANDUM 
Maricopa County Schools Superintendent Office 
TO: 	
CLERK OF THE BOARD 
FROM: 	
Terri Ysaguirre 
SUBJECT: Affidavits — Replacement of Lost Warrants 
DATE: 	
1/6/2020 
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 
terrLysaguirre@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. 
#65 	
Littleton Elementary 	
Beaney Payan 	
$344.15

Signed: 	
(4) 
c--
rilber  20 /9. 
bscribed and swor 
o befo me this 	
day of-ce 
 
NOTARY PUBLIC 
My ,commission expires: 
?c). 
ANAMARIA OIJINITANILLA 
Notary Public • State of Arizona 
MARICOPA COUNTY 
Commission #545714 
Expires May 15, 2022 
(seal) 
ERK, BOARD OF SUPERVISORS 
MARICOPA COUNTY 
Schools Affidavit/Claim Form 
Application for a Duelicate Warrant/Check (definitions are  on page 2) 
STATE OF ARIZONA 
COUNTY OF MARICOPA 
a 
	
 
131MWCIS ma 
Note: Numbers on this form correspond to numbers on the 
Instruction sheet which Is page 2 of this form. 
(1), being first sworn, upon oath deposes and says: 
On or about  1- 	(90 / c, 	
(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, gr 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/hepn/he sum of $  944. 	
.(3) 
Note: Please attach a copy of the warranVcheck If available and/or any other 
evidence that a warrant/check was originally issued. 
Warrant/Check Number 
(if known) (6) 
_ 
370 0/3P9-70— 
. 
Original Date of Issue 
(If blown) (7) 
q/e
A? 
i 
APPROVED [ 
Reksos for original Issue of Warrant/Check (8): 
Payroll 
0 For Services or Goods furnished 	
 
0 Other: 	
 
S:WROCESSERWanints - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of dalin.doc 
Revised June 2015 	
/AS. 11-632 & 15-999