STAMPED & REDACTED UNITED REFRIDGERATION INC.PDF

INTEROFFICE MEMORANDUM

Maricopa County Schools Superintendent Office a

TO: CLERK OF THE BOARD

FROM: Terri Ysaguirre

SUBJECT: Affidavits - Replacement of Lost Warrants
DATE: 8/30/2021

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.

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.

#62 Union Elementary United Refrigeration Inc $181.70

RECEIVED

AUG 31 2021

MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS

Dn brotelyaol AF

UNITED REFRIGERATION Inc.

CREDIT DEPARTMENT

@

To Whorn it May Concern,
Please accept this letter advising that toa tefedhes the authority on behalf of
Undid Kepedes c., to sign the Application/AffidaviNor a Duplicate Warrant/Check.

Should you have any questions, please do not hesitate to contact our office at

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.
United Refrideration Inc. (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about (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 arnount shown is due and owing, and the applicant requests that a replacement

ae vee to him/her in the sum of ¢ 181 10 (3)
Signed: day idl itr) (4)

(5) Subscribed and sworn to before me this /Gth day of 2e2l_.

hake ~
NOTARY PUBLI
commission expires: { GEL SHARON KAYE DIODATO
aft a ID #10850028
; 3 » My Commission Expires (seal)
ite

February. 16, 2022

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 3700426209 / 62562190

(if known) (6)

Original Date of Issue 195 /49/2021

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

C1 Payroll : :
fl For Services or Goods furnished APPA YV Y ZW

Other: rf 08/31/2021

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