ORIGINAL STEPHANIE D LOYER.PDF

Maricopa County — Formal (2021-09-01)

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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: 8/9/2021

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.

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.

#44 Avondale Elementary Stephanie D Loyer $97.19

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Application for a Duplicate or Stale-Dated Warrant/Check

Affidavit/Claim Form

This application is for: fal Duplicate or CO State-Dated (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.
LOYER, STEPHANIED (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about 8/6/2020 (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

warrant/check be issued to-him/her in the sum of $97.1 9 (3)

Signed: OAZN (4)
WTO TV

Note, Please attach a co, f the warrant/check if available and/or any other
evidence that a warrant/checK was originally issued.

(5) Subscribed and sworn to before me this od day of Auacss 204. \.
a ce

NOTMRY PUBLIC SN

(seal)

Original Date of Issue
(if known) (7) 8/6/2020

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

C1 For Services or Goods furnished

1 Treasurer's refund/payment
O Other:

S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc
Revised April 2015 A.R.S. 11-632 & 11-644