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INTEROFFICE MEMORANDUM Yvtaricopa County ScfiodSuperintendent's Offic RECEIVED TO: CLEWK, DIE 00..4 JUN 1 2 2019 FROM: .Wiffie 'Thompson MAR ICOPA COUNTY CLERK BOARD OF SUPERVISOR SUBJECT: Affidavits DATE: 6/12/2019 PThase find attached 1 AffidavitOotice of Claim(s)for lost -warrants for inclusion on the next avaiCa6 Ooard agenda The attached item(s) have 6een researched to ensure that the warrant(s) in question have not 6een cashed or previously re-issued The original-warrant(s) have had a stop payment done. If you have any questions, please contact Marie 'Thompson at 372-1244 or via e-mail at mthompson@maricopa.gov . Approved Affidavits may he routed back to the Superintendent of School - Einance Division at 4041 X Central Avenue #1200, ( 12 tfi foor) Thankyou. # 98 'Fountain .711Cls. Jessica Willer $421.65 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. .ar SS! r_ /(4 el y- (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 5 /i 0 (date) )(2) (2) a warrant/check was issued to the 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 $ I, S .(3 ) A Signed: (4) (5) ubscri d and sworn to befor3 me this U3' day of 2011. AAA C.• . NOTARY PUBLIC CAROLINE OF}-1e1AL C. SEAL LYNCH ) Commission Notary Public - Stale #340211 ol Ari:ana My cortimission xpires: My MARICOPA comm. expires June COUNTY 22 ;,!1••• ‘) I .§-6-51) 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 (if known) (6) 37 000 5 1 ii. Original Date of Issue / (if known) (7) 5 3/ Q0/R Reason for original issue of Warrant/Check (8): Ni Payroll • For Services or Goods furnished • Other: SAPROCESSES\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 r rant ncimber: H.. du: tv1CTO-L'irf'1.:107 In -./oice_ date: . ddte: Poid chte: 5/3112019 us: Stale pay .5ent ,Jat Exception flag: Agency details ;,.iienc , • 21 it p.(:Alve pay: (la nnbcr fc::r onole: ,Acienc , PO roJrnhtr; Registered • Ii HId r:atc [ET:le-red: .-gP pt nw Ii (.4 0 i!YtEre."7,rt rate! 0,0c0o0 Warrant Lines Amount Payee Account 421.65 Miller, Jessica B