STAMPED AND REDACTED - 3700883565 - SANDRA SKEENS.PDF

Schools Affidavit/Claim Form 
Application for a Duplicate Warrant/Check 
(definitions are on page 2) 
STATE OF ARIZONA 
COUNTY OF MARICOPA 
Note: Numbers on this form correspond to number̉ on the 
Instruction sheet which Is page 2 of this form. 
_S_A_N_D_R_A_S_K_E_E_N_S ___ (1), being first sworn, upon oath deposes and says: 
Name/Claimant 
On or about 07/01/2025 
(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 $_3_7_0_.0_0 ______ , (3)
//\ 
1 
t}' 
. I 
Signed: V o,w'a//V(lfJ' J/lJ:Jv\4--'
(4) 
Print name: (required) SANDRA SKEENS 
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 
3700883565 
/If known) (6) 
Original Date of Issue 
07/01/2025 
(If known) (7) 
Reason for original issue of Warrant/Check (8): 
D Payroll 
D For Services or Goods furnished. ___________ _ 
1!!1 Other: 
REFUND CHECK 401665765 LOST IN MAIL 
S:\FlnanceDesk\Schools·Warrants Checks notice of clalm.docx 
Revised May 2025 
A,R,S. 11-632 & 15-999