STAMPED & REDACTED AUTO SAFETY HOUSE.PDF
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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: 8/19/2021 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. #79 Litchfield Elementary Auto Safety House $249.36 RECEIVE D AUG 19 202) MARICOpa Co CLERK BOARD OF SUE son s Moul Ag 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. AUTO SAFETY HOUSE (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 06/03/2021 (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. 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 OOO in the sum of $249.36 _ 3) Signed: (4) Cane (5) Subscribed and sworn to before me this “ZS day of solue 202\ . we Ortereere. Ca wok NOTARY PUBLIC MARIA |. CASTILLO NOTARY PUBLIC ARIZONA MARICOPA COUNTY MY COMMISSION EXPIRES JUNE 08, 2022 (seal) My commission expires: | fae Se 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 Number |3799431432/79740898 (if known) (6) Original Date of Issue 06/03/2021 (if known) (7) Reason for original issue of Warrant/Check (8): O Payroll f@ For Services or Goods furnished O Other: 08/20/2021 S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc Revised June 2015 A.R.S. 11-632 & 15-999 Quality since 1941 TOTAL FLEET SOLUTIONS 08/13/2021 To whom it may concern: Christa Taylor is authorized to sign the Schools Affidavit/ Claim Form. For the replacement of check, rendering payment for parts and services received from Auto Safety House. Questions or concerns please contact Accounting Manager. Patt May Brett Moser Accounting Manager