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INTEROFFICE MEMORANDUM Waricopa County School -Superintendent's Office RECEIVED TO: CLERX0EYEWARD FROM: Wiffie Thompson JUN 2 8 2019 SUBJECT: Affidavits MARICOPA COUNTY DATE: 6/26/2019 CLERK BOARD OF SUPERVISORS Prease find attached 1 Affidavittg\rotice of Claim(s)for Cost warrants for incrusion on the nek-t avadahre oard agenda 'The attached item(s) have heen researched to ensure that the warrant(s) in question have not heen cashed or previously re-issued The original warrant (s) have had a stop payment done. If you have any questions, p lease contact Willie Thompson at 372-1244 or via e-mail at mthompson@maricopa.gov . Approved Affidavits may he routed hack to the Superintendent of School finance Division at 4041 X. Central -Avenue #1200, ( 12 th ECoor) Thankyou. #17 TOLLESON - ELE511 10101. ERAZIER $4353.00 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. JOHN FRAZIER (1), being first sworn, upon oath deposes and says: Name/Claimant it On or about 0(4 o c:Qo tcl (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/che is ed to him/12r,in the sum of $ 5451.94 ef3 09€3 (3) iort,ds'S (4) (5) Sybscribe 'orn to before me this / 7iJ day of 20 . NOTARY PUBLIC My commission expires: 6)12(./z6z.7— Note: Please attach a copy of the warrant/check if available and/Or:any othe' evidence that a warrant/check was originally issued. Warrant/Check Number 3700185697 (if known) (6) Original Date of Issue 06/04/2019 JUR/ 8 2019 (if known) (7) A. Reason for original issue of Warrant/Check (8): El Payroll 0 For Services or Goods furnished 0 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 Warrant header General Posting ,,',"•.31-flIlt. number: Holden NICTOCC:007. 11--poice date: tied date: 6/4/2019 12:00:0D am Pdrd date: Stopped pa :( clate: 5/24/2019 12:00:02 pm Iraq: Agency details . 7 Cr: I , -•. 1•1, 612 pc•s:itIvE pay: Registered --terc 0 - rate: 0,00000 Warrant Lines Amount Payee Account 4,353,00 FRAZIER, JOHN