STAMPED & REDACTED TRANE US INC.PDF

INTEROFFICE MEMORANDUM

Maricopa County Schools Superintendent Office

TO: CLERK OF THE BOARD

FROM: Terri Ysaguirre

SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 11/17/2021

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.

#59 Laveen Elementary Trane US Inc $354.51

RECEIVED |

Nov 18 2021 |

MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS

Si roraice voil-AF

Application for a Duplicate or Stale-Dated Warrant/ Check

Affidavit/ Claim Form

This application is for: Duplicate or C1 state-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.
Trane U.S. Inc. (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about 07/06/2021 (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 $ 354.51 -(3)
Signed: [ogy bape (4)

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__22nd__day of _September 20.21
NOTARY PUBLIC
My commission expires:
12/26/2021 (seal)
Warrant/Check Number *
(if known) (6) 3700439710
Original Date of Issue ~
fryers 07/06/2021
Reason for original issue of Warrant/Check (8):
C1 Payroll
For Services or Goods furnished
O Treasurer's refund/payment 11/19/2021

O Other:

S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Check
Revised April 2015