STAMPED DANIEL LOPEZ .PDF

Maricopa County — Formal (2021-10-06)

View PDF Item 91 Meeting page

Extracted text (via ocr_local) 2518 characters
INTEROFFICE MEMORANDUM

Maricopa County Schools Superintendent Office

TO: CLERK OF THE BOARD

FROM: Terri Ysaguirre

SUBJECT: Affidavits - Replacement of Lost Warrants
DATE: 9/15/2021

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.

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.

#21 Murphy Elementary Daniel Lopez $1,772.51

RECEWED
SEP 16 2024

gicoPA COUNTY ag
CLERK BOARD OF SURERVISO

\um

“

Schools Affidavit/Claim 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.
‘
ie (1), being first sworn, upon oath deposes and says:

ame/Claiman

On or about 2) 3112021 (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, undef penalty of perjury, claimant hereby affirms that this claim is correct
and the amount in is due and owing, and the applicant requests that a replacement

issued to him/her in the sum of $ j1qa. e) ] (3)

warrant/cheg

Signed:

/ (4)
ie.

(5) Subscribed \ahal sworn to before me this _ | day of Suplenbor 200-).

Sal | :

TIFRANY IOFINSON

M ission expires: J
'&} Notary Public - State of Arizona

By A7o— 5) YAVAPALCOUNTY (seal)
Comm. #580001 Exp./July 28, 2022

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

W. t/Check Numb
ara | 21332553

Original Date of Issue

(if known) (7) fey a 2) | ada-|

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

OO For Services or Goods furnished 09/17/2021
O Other: -

S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warran_ _..-
Revised June 2015 A.R.S. 11-632 & 15-999