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INTEROFFICE MEMORANDUM Maricopa County Schools Superintendent Office ) -_ ae RECEIVED Tk TO: CLERK OF THE BOARD : a FROM: Terri Ysaguirre MAR SUBJECT: Affidavits - Replacement of Lost Warrants CLERK BOA‘ DATE: 10/20/2021 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. #44 Liberty Elementary Giselle Guyer $1,195.75 Schools Affidavit/Ciaim 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. Giselle Guyer (1), being first sworn, upon oath deposes and says: Name/Claimant . On or about lo] S] Z\ (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 (3) (4) (5) Subscribed and sworn to before me this | S day of Oclcloei- 20'.)\. UNaloath CL Divas NOTARY PUBLIC Maleah Collins Notary Public . Maricopa County, Arizona My commission expires: My Comm. Expires 10-03-24 10-03. OY . Commission No. 589202 (sal) v 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) 3700471707 Original Date of Issue on it known) (2) 10/5/2021 Reason for original issue of Warrant/Check (8): Payroll C1 For Services or Goods furnished___ 10/22/2021 OO Other: . S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools: Revised June 2015 A.K.D, 11-092 & 19-yIY