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INTEROFFICE MEMORANDUM Maricopa County Education Service Agency (aka Maricopa County Superintendent of Schools Office) TO: CLERK OF THE BOARD FROM: Terri Ysaguirre SUBJECT: Affidavits — Replacement of Lost Warrants DATE: 4/22/2019 #2 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. V 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 terrieysaguirre@mcesa.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. #65 Littleton Elementary Sarah R Steward $228.14 RECEIVED APR 23 2019 MARICOPA COUNTY CLERK BOARD OF SUPERVISORS 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. Sar;Vrahu S4t LAct "et (1), being first sworn, upon oath deposes and says: On or about tS- 6.)(Di Cr (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, pi 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) Signed: (4) ,5) Subscribed and sw, NOTARY PUBLIC ANAMARIAQUINTANILLA V.:116,001 MyAcommission expires: Notary MARICOPA Putao • St* COUNTY of &Wail Commission Expires May # 15, 540714 2022 (seal) Note: Please attach a copy of the warrant/check If available and/or any other evidence that a warranVchecic was originally Issued. Warrant/Check Number (If known) (6) 5 7oo Ozico 9 Co (o . Original Date of Issue up , AP),f 3 oa (If known) (7) Co -* /6— ---) ir //.4,14,,, Reason for original issue of Warrant/Check (8): ROAij, := SUPERVISORS Payroll ID For Services or Goods furnished 13 Other: S:\PROCESSES\Warrants Revised June 2015 - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of clalm.doc A.R.S. 11-632 & 15•999