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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: 8/5/2021 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. #401 East Valley Institute of Tech Veronica Aguiar $2,068.75 MARIGOF CLERK BOARD OF 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. Ver Binica Agus UAC (1), being first sworn, upon oath deposes and says: cea On or about _d7/a)/aca| (date)(2) a warrant/check was issued to the above named a 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 mae be issued to him/her in the sum of $ JD, 0U8. Wiel (3) Chey (4) hf. Signed: \ 9) 5) Subscribed and sworn before me this a _ day of Ulug ‘ 20 2] , NOTARY PUBLIG TAMMY NORRIS Notary Public - Arizona Maricopa Count Commission # 577175 My Comm. Expires Jan. 5, 2024 (seal) My "4 ission expires: bees 2d 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 55 fen (if known) (6) BYOOFLS IID Original Date of Issue - (if known) (7) O72 1d Reason for original issue of Warrant/Check (8): 1 Payroll C For Services or Goods furnished 08/06/2021 wo other; S/udeot ye fund 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 I Veronica Aguiar did not receive check 3700448525. The check was discarded by the person that lives in my old apartment. UL Le (Signature) gluls| (Date)