SATMPED & REDACTED BACK TO SCHOOL CLOTHING DRIVE.PDF

Maricopa County — Formal (2021-12-08)

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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: 11/10/2021

Please find attached 1 Affidavit/Notice of Claim(s) for lost warrants for inclusion on the next
available Board agenda

Vv The attached item(s) have been researched to ensure that the warrant(s) in question have
not been cashed or previously re-issued.

Vv 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.

#59 Laveen Elementary Back to School Clothing Drive $1,522.81

RECEIVED
Nov 14 2021

MARC OUNTY ;
CLERK BOA UPERVISORS

Lytorngh wou - AF

og

Application for a Duplicate or Stale-Dated Warrant/ Check
Affidavit/ Claim Form

This application is for: Duplicate or C1 stale-Dated (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.

BACK TO SCHOOL CLOTHING DRIVE (1)
Name/Claimant '

being first sworn, upon oath deposes and says:

On or about 02/11/2021 (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 him/her in the sum of $1, 522.81 (3)

Signed: Ginette Fic, (4)

Note: pie. attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.

(5) sue and sworn to before me this CD day (LL __ 20 ZL

—— ae
NOTARY PUBLIC
‘Net Pt.
My commission Serres: Mertcopa County, Artzona
UA- 2 - 7 My Comm, Exes 0228-28 (seal)
Warrant/Check Number
ee 3700398556
Original Date of Issue -
(if known) (7) 02/11/2021
Reason for original issue of Warrant/Check (8):
O Payroll 11/18/2021

For Services or Goods furnished
QO Treasurer's refund/payment
O 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

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October 20, 2021

| Karl Gentles, a representative of Back to School Clothing Drive, state that payment for goods or
services provided to the Laveen school District was not received. The check in the amount of 1522.81
has been declared lost in the mail. Janette Lopez, also a representative of Back To School Clothing
Drive, has presented an affidavit for signature before a Notary Public.

KarLGentles
Executive Director

Pusey
J te Lopez

Director of Programs

Phoenix AZ