STAMPED & REDACTED EDUCATIONAL FURNISHINGS.PDF

INTEROFFICE MEMORANDUM

Maricopa County Schools Superintendent Office

TO: CLERK OF THE BOARD

FROM: Terri Ysaguirre

SUBJECT: Affidavits ~ Replacement of Lost Warrants
DATE: 6/24/2021

-(1
Please find feacned 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.

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.

#5 Isaac School District Educational Furnishings $1,123.29

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.
onal Fuyn ishihgs (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about Uavelh 23,2091 (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

arin issued to him/her in the sum of $ [, 123,04 : (3)
Signed: {hes \ 90 9 — (4)

10 day of June 2021.

ibed and sworn to before me this

Notary Public, State of Arizona
Maricopa County
Commission #593163

a} a . My Commission Expires
My commission expires: November 10, 2024

AlOv._L0, 2024 bal)

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

all TeV Maa 3)- 6040 44 08/19/2021
Original Pate of (sue 23 33-91 -
Reason for original issue of Warrant/Check (8):

O Payroll ,

@ For Services or Goods furnished Geods fun shef

1 Other:

S:\PROCESSES\Watrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc
Revised June 2015 : : - ARS. 11-632 & 15-999

u ishings

Isaac School District
Atten: Patty Duarte

Date: 07/21/2021

To whom it may concern. Please acknowledge Melissa Williams as not only our owner, but also an
authorized signer in all aspects of the business.

Thank you,
Elma Shaw writing for Melissa Williams.

Please see Melissa Williams signature of acknowledgement.

We testa reverereas 1:21. 202

Signature

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