STAMPED STEPHANIE MURRAY.PDF

Maricopa County — Formal (2021-11-03)

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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: 10/20/2021

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.

#44 Avondale Elementary Stephanie Murray $1,064.68

OCT 21 2021

_ MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS

Tntor ofbee Merl -AF

Application for a Duplicate or Stale-Dated Warrant/ Check

Affidavit/Claim Form

This application is for: fal Duplicate or CO 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.
MURRAY, STEPHANIE (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about 7/29/21 (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

watrant/check be issued to him/her in the sum of $ 1064.68 (3)

Signed: SHtihow Wy (4)

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

ae) and sworn to b re me this IS th day of Septem ber 20 24 .

L- bl and hae
NOTARY PUBLIC t
Dulce A Martinez
Notary Public - Arizona
My commission expires: } M Pacha savaa oe 3a
iy im. ha
° Sommisslon No, §69157 (seal)
Warrant/Check Number
tron (6) 3700447656
Original Date of Issue
(if known) (7) 7. 29/. 21
Reason for original issue of Warrant/Check (8):
Payroll
C1 For Services or Goods furnished 10/22/2021
 Treasurer’s refund/payment -
1 Other:

S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice or ciaim - Vopy.uue
Revised April 2015 ARS. 11-632 & 11-644