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INTEROFFICE MEMORANDUM Maricopa County Education Service Agency (aka Maricopa County Superintendent of Schools Office) RECEIVEb APR -3 2019 TO: CLERK OF THE BOARD MARICOPA Cot 'NTY FROM: Terri Ysaguirre CLERK BOARD OF SUf ER VISORS SUBJECT: Affidavits — Replacement of Lost Warrants DATE: 4/3/2019 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 terri.ysaguirre@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. #216 Agua Fria Union CPR Savers & First Aid Supply $113.72 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: 11 Duplicate or El Stale-Dated (definitions are on page 2) STATE OF ARIZONA Note: Numbers on this form correspond to numbers on the (Pe COUNTY OF MA ICOP.A Instruction sheet which is page 2 of this form. cq;‘-hci* • t. I\ tft& (1), being first sworn, upon oath deposes and says: a e '4 at an On or about 0//3/1F3 (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 $ I 13. .7`Q .(3 ) Signed: (4) Note: Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. (5) Skscribed anJ sworn o before me this A? day of /1 e-4 20 l? . 1-4 NOTARY PUBLIC DARRYL E COOPER Notary Public,State of Arizona My g9mmission expires: My Maricopa Commission County Expires t r5 .52a7 October 09, 2019 (seal) Warrant/Check Number I (if known) (6) J167(P)L-13P) Original Date of Issue APPROVED (if known) (7) Reason for original issue of Warrant/Check (8): 0 Payroll Prt7i3P MAilICOPA COUNTY X For Services or Goods furnished El Treasurer's refund/payment 0 Other: S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc Revised April 2015 A.R.S. 11-632 & 11-644 RIM P R Savers & FIRST AID SUPPLY' March 29, 2019 Dear Accounts Payable, We are writing this letter to inform you that our company CPR Savers & First Aid Supply did not receive your check # 216723498 dated 12/13/2018 in the amount of $113.72. We are requesting this check be re-issued as soon as possible please as it is over 90 days past due. We are also making you aware that our employee Maira Alston is indeed an authorized signed for our company and is authorized to complete and return this Affidavit / Claim form. Thank you. Sincerely, Susan Taylor - President 7904 E. Chaparral Rd. • Ste A 110-242 • Scottsdale, AZ 85250 Phone: 1-800-480-1277 • Fax: 1-480-946-2457