STAMPED LUCAS WAYNE RAY.PDF

Maricopa County — Formal (2021-09-15)

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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.

LUCAS sy (1), being first sworn, upon oath deposes and says:
ame/Ciaiman

On or about 124 l2\ (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

a ae wa in the sum of $ 1211 a4 (3)
Signed: “CU : L G2-Y (4)

7

(5) Subscribed and sworn to before me this | © day of Ay AS ust 20 2].

( pact Ags Mure
| 6Sl&  CYNTHIASKORO :

NOTARY PUBLIC
: Nolary Public - State of Anzana |

My commission expires: ee)

PINALCOUNTS |
> y _ Commission # 59818é
ol/ 1/0 [2 QQS Se” Expires February 10, 202° (seal)

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

t/Check Num : : BWerY Ae
Warrant/Check wumber | A9ASASD | 3100446193
Original Date of I 2
vgn (if known) ao Aen | \

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

C1 For Services or Goods furnished
1 Other:

08/17/2021

S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schc
Revised June 2015