STAMPED AND REDACTED - 3700927443 - FLEETPRIDE.PDF
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Schools Affidavit/Claim Form Application for a Duplicate warrant/check MARCOPA COUNTY (definitions ere on page 2) ST ATE OF ARIZONA COUNTY OF MARICOPA Note: Numbers on this form correspond to numbers on the lnstrucUon sheet which Is page 2 of this form. _F_le_e_tP_r_ld_e-'-,_ln_c _____ (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 12/Q4/?025 (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, w: 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/ch 215.40 () ______ . 3 before me thisɥ 3 day of , )v:ne.. 20a, ® Abbey R, Nichol$ . My Commlulon expires 1112212026 Notary ID 134077201 (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 3700927443 /If known\ 16\ Original Date of Issue 12/04/2025 llf known\ 17\ Reason for original Issue of Warrant/Check (8): D Payroll ii For Services or Goods furnished ____________ _ D Other: S:\AnanceDesk\Schools¿Warrants Checks notice of clalm.docx Revised May 2025 A.R.S. I 1-632 & l5•999