STAMPED ELIZABETH ROJAS-NUGENT.PDF

INTEROFFICE MEMORANDUM

Maricopa County Schools Superintendent Office

TO: CLERK OF THE BOARD

FROM: Terri Ysaguirre

SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 8/2/2021

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 Elizabeth Rojas-Nugent $1,255.60

RECEIVED

AUG 04 2021

MARICOPA COUNTY
CLERK BOARD OF SUPER SS ORS

pbaroere var

AX

Schools Affidavit/Claim Form

Application fora Duplicate Warrant/Check (definitions are on page 2)

STATE OF ARIZONA
COUNTY OF MARICOPA

ROJAS-NUGENT, ELIZABETH

Note: Numbers on this form correspond to numbers on the
Instruction sheet which is page 2 of this form.

(1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about July 27, 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

at 10a sum of $ 1255.60 (3)
Signed: (4)
(5) Subscribed and.snom to before me this 30 dayof_Du Ive 20_c2l.
NOTARY PYBLIC
Sime Noy Pubes Sitt Azo
My commission expires: is) Commission # 590188
2} lofonos RE expires February 10, 2025 (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 Number
vit inn) (6) 3700448881
Original Dat I
riginel Date of ssue 07/27/21

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

@ Payroll
08/04/2021
0 For Services or Goods furnished , =

O Other:

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