STAMPED & REDACTED MOHAMED ABDELRAHMAN.PDF

Maricopa County — Formal (2021-10-20)

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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: 9/27/2021

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.

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 Mohamed Abdelrahman $145.00

RECEIVED

sep 28 2021

TY
ARICOPA COUN
CLERK BOARD OF SUPERVISORS

Application for a Duplicate or Stale-Dated Warrant/Check

Affidavit/Claim Form

This application is for: ml 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.

Mohamed Abdelrahman

Name/Claimant

On or about 8/10/2021 (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.

(1), being first sworn, upon oath deposes and says:

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 issuigd to him/her in the sum of $ 145.00 (3)
Signed: _ = (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_ /@__day of September 20 21.

~~ Ar—~

NOTARY PUBLIC

BRIAN REASOR

wi 5 z Notary Public - Arizona
My commission expires: Pinal County

Commission # 583705
a) 2; OE, 2024 Ee” My Comm. Expires Jul 8, 2024 (seal)

Warrant/Check Number
AF keer) (6 3700455598

Original Date of Issue 8/10/2021

(if known) (7)

Reason for original issue of Warrant/Check (8):
O Payroll

ll For Services or Goods furnished : -

09/29/2021

O Treasurer’s refund/payment

W Other: Pavent refund

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

Terri Ysaguirre (CSS)

From: FinanceDesk (CSS)
Subject: FW: #3700455598 for $145

From: Sanchez, Cynthia

Sent: Monday, September 27, 2021 10:25 AM
To: FinanceDesk (CSS)

Subject: #3700455598 for $145

Hello FinanceDesk,

Parent Mohamed Abdelrahman was issued a refund check for preschool/childcare tuition. The parent
and child moved away from the District. The refund check issued was declared lost in the mail. An
affidavit has been submitted for the reissue of the check.

Thank You,

Cynthia Sanchez

Accounts Payable Bookkeeper
Laveen Elementary School District
Phone: (602)

Fax (602)