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INTEROFFICE MEMORANDUM 911aricopa County School" Superintendent's Office RECEIVED TO: CLERXOE EHE 00ARD FROM: Yale Thompson MAR 2 5 2019 SUBJECT: Affidavits CLERK mARicoPA BOARD OF COUNTY DATE: 3/22/2019 SUPERVISORS Pase find attached 1 AffidavitOotice of CCaim(s)for Cost warrants for inclusion on the next avadafiTh cBoarcfagendTa 'The attached item(s) have been researched to ensure that the warrant(s) in question have not been cashed or previously re-issued The original-warrant(s) have had a stop payment done. If you have any questions, please contact Millie Thompson at 372-1244 or via e-mail at mthompson@maricopa.gov . Approved Affidavits may be routed back, to the Superintendent of School finance Division at 4041 W: Central Avenue #1200, ( 12 th (Floor) Thankyou. #94 PAA LOU EVIVRES YrEALMARE $1275.00 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. (1), being first sworn, upon oath deposes and says: On or about 1\\ \\A Van (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/chese issued to him/her in the sum of $ 1275.00 .( 3) Signed: _ / 44.'140 (4) (5) Subscribed and sworn to before me this J7 - day of NOTARY PUBLIC My commission expires: Olo,A )3, re Note: Please attach a copy of the warrant/check if available ahdiciripAotchep • ? 3 A evidence that a warrant/check was originally issued. Warrant/Check Number 94522154 ,..3 fr Co I oG Lt 7_ (if known) (6) Original Date of Issue 11/14/2018 (if known) (7) hhl.fk si Reason for original issue of Warrant/Check (8): El Payroll MARICOPA COUNTY Ill For Services or Goods furnished Special Education Services 11] Other: Special Education Services 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 IIMFAInie %MAN Discover A Better Way Forward"' February 28, 2019 RE: Vendor Letter To Whom It May Concern: I, Erin Edwards, President of The Futures HealthCore, LLC (dba Futures Education, LLC) acknowledge that Laurette T. Bishop has full signing authority for The Futures HealthCore, LLC (dba Futures Education, LLC). Please accept this letter of authorization for such purpose. Please let me know if you need any further information. Thank you. Sincerely, Erin Edwards, Ed.D., CCC/S-LP President FUTURES EDUCATION FUTURES HEALTHCORE 36 William Street Springfield, MA 01105 1 800 218 9280 F 866 656 6111 DiscoverFutures.com 9 Warrant header General Posting ;irnnt number; 3700110647 Invoice: Hetder; MCT0000330107 ILOICC ::ate: red date: 11/14/201B 12:00:00 am Pa:d Stopped Porj - pa y- rrent date: 11/15/2018 12:00:47 pm Agency details rc.Tyyr.n. kone ;IA ency ,..-cucher number 1023 :Dur:13€-ci for positive pay. 4.genc 3 clam numbEr ;s.cienc,.,f low oricu LO ,SI,Rri for reconcile: Agenc f,' PO number: Registered Agency sub fund: Date rr ;24yEO( 1Irb non -i: int e .t e rTh 0 -,tere.5t rate: 0,000W Warrant Lines Amount Payee Account . 1,275,00 FUTURES - 31)413- 94-4 I OC: - .„