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INTEROFFICE MEMORANDUM Maricopa County Education Service Agency (aka Maricopa County Superintendent of Schools Office) RECEIVE) TO: CLERK OF THE BOARD MAR 2 8 2019 FROM: Terri Ysaguirre MARICOPA SUBJECT: Affidavits — Replacement of Lost Warrants CLERK BOARD OF SUPLHVISORS DATE: 3/28/2019 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. #65 Littleton Elementary Paula Z Hernandez $1,204.79 #65 Littleton Elementary Tatum Green $199.11 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: 0 Duplicate or 0 Stale-Dated (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. ---PckA4c1 Name/Claimant /--kv, ncii--/ck 41), being first sworn, upon oath deposes and says: On or about (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, glr 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/che9lle issueditopim/her in the sum of $ R -7 ci .(3) Signed: (4) Note:' Please attach a co/9Y of the' warrant/check if available and/or any other evidence that a warrant/check was originally issued. (5) Subscribed an sworn to before me this 0- 'Ds day of Marth 20 19 . „Kea • ruff -"AraiWiz NOTARY _ ELBA M. LOZANO Notary Public- Stale of Arizona My commission expires: My MARICOPA Commission COUNTY Explret Notea i9e-rX-1 10C271 I islovemlw P7, 021 (seal) Warrant/Check Number (if known) (6) '3 7 (X) I Ltcl Original Date of Issue (if known) (7) 3/5/i9 Relsln for original issue of Warrant/Check (8): DATE _APR O4 2019 Payroll 0 For Services or Goods furnished YRICOPA COUNTY 0 Treasurer's refund/payment 0 Other: S:\PROCESSES\Warrants Revised April 2015 - Duplicate or Stale\02 FormsWarrants Checks notice of claim - Copy.doc A.R.S. 11-632 8( 11-644