STAMPED LAKEN LYNN OWEN.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: 8/27/2021

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.

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.

#95 Queen Creek Unified Laken Lynn Owen $1,527.83

RECEN ED

nue 30 202)

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.
OWEN, LAKEN LYNN (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about O10 |A03\ (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

wantantichese Ne issued to him/her in the sum of $1 ,527.83 (3)

y

Signed: i Lin ( an. (4)

(5) Subscribed and sworn to before me this ly day of Hass ust 20_Q]|
Caan Aah os Shins

NOTARY PUBLIC
CYNTHIA SKORO
My commission expires: Notary Public - Stale of Aezona
PINAL COUN”

4s/ Commission # 598 1
Expires February 10. 2025;

Al10 AT (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
arrant/Check Number 13700454288

roneignon [08/10/2021

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

1 For Services or Goods furnished
C1 Other: 08/31/2021

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