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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: 8/11/2021
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.
#95 Queen Creek Unified Ellie Anne McCabe $1,211.92
F dese .
#95 Queen Creek Unified Lucas Wayne Ray $1,277.39
RECEIVED
AUG 13 2021
MARICOPA COUNTY
a BOARD OF SUPERVISORS
fror’|
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.
Etuc Me Carer (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about ‘Uerla (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 $ VOW (3)
Signed: {MAA WALA, (4)
(5) Subscribed and sworn to before me this [ D_day of _Ay ; gg 20_2].
A facet dre a 1 Dh AAI
NOTARY PUBLIC
. CYNTHIA SKORG:
wo. + Notary Public - State o! Arzorv:
My commission expires: G PINAL COUNTY i
ommission # §98188 |
o// fo) hk O65 Expires February 10. 2025! (seal)
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 Numb ‘ - ; . ;
frome 85695402, | Mwo4asWeS
Original Date of Issue “1
9 (if known) (7) lon la
Reason for original issue of Warrant/Check (8):
Payroll
(1 For Services or Goods furnished
C] Other: 08/17/2021
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-VV
Revised June 2015