STAMPED & REDACTED TEACHER DIRECT.PDF

INTEROFFICE MEMORANDUM

Maricopa County Schools Superintendent Office

TO: CLERK OF THE BOARD

FROM: Terri Ysaguirre

SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 11/ Toit ty

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.

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.

#49 Palo Verde Elementary Teacher Direct $90.68

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Schools Affidavit/Claim Form

Application for a Duplicate Warrant/ Check (definitions areon page 2)

STATE OF ARIZONA Note: Numberson this form correspond to. numbers on the
COUNTY OF MARICOPA Instruction sheet'which is:page 2 of this form.
“Ted. ( hay Divect (1), being first sworn, upon oath deposes and says:
rame/Ciaiman' .

On or about 5s a5 QAI (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 $ A0, OC fe) (3)
Signed: dhe aor WL DAA (4)

(5) Subscribed and sworn to before me this qth day of / lovem br 20 | F

NOTARY BUBLIC

My commission expires:
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Note: Please attach a copy of the warrant/check if available and/or any other
evidence that @ warrant/check was originally isstied.

Warrant/Check Number . ~
(if known) (6) 700 42® 069
Original Date of Issue a =
i (if known) (7) 5 i 25 ' 2.0 2\
Reason for original issue of Warrant/Check (8):
© Payroll

a4 For Services or Goods furnished + eacher Siupol 12S
O Other:

11/23/2021

§:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Che .
Revised June 2015:

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November 10, 2021

Palo Verde Elementary District
Palo Verde, AZ 85343
To Whom It May Concern:

Teacher Direct (TDSA, LLC) did not receive check# 3700428063 (as noted on the claim form) in the
amount of $90.68. We were advised by Palo Verde Elementary District that we would need to sign an
Affidavit and have it notarized. Please see the attached notarized form as you requested with Heather
Mckown’s signature as the witness from Teacher Direct who has the authority to sign the form.

Please let me know if you have any questions.

Respectfully,

Lori Echols, Controller

‘Teacher Direct

Birmingham, Al 35208
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