PITTERSON.PDF

INTEROFFICE MEMORANDUM
Waricopa County School -Superintendent's Office
TO: CLERX OF Da (J30A W9)
FROM: Millie Thompson
SUBJECT: Affidavits
DATE: 3/19/2019
Pase find attached 1 AffidavitOotice of Cfaim(s)for lost warrants for inclusion on
the ne.v available Ooard agenda
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 crone.
If you have any questions, please contact Millie Thompson at 372-1244 or via e-mail at
mthompson@mcesa.maricopa.gov . Approved Affidavits may be routed back to the
Superintendent of School" Finance Division at 4041 X. CentrarAvenue #1200, ( 12 th
Efoor) Thankyou.
#60 YaGLET XTYglIOND (PI1e1R5'01V - $994.67
RECEIVED
MAR 19 ?DJ
MARICOPA C;OUNTY
CLERK BOARD OF SUPERVISORS
f/ô CO_

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.
Raymond Pitterson (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about .22 )) /19 (clate)(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 $ 994 .67 .(3)
(4)
(5) Subscribed and sworn to before me this 3 day of /;-- 2Ol.
OFFICIAL SEAL ii
AN E-11 EICINTILI19
Notary Pubic - State of Arizona
MARICOPA COUNTY
My commission expires: N'ztliJr6-7 Corm 4556033 Exp. Nov. 5, 2022 !,
(seal)
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 60587784 i 37 Do( (4 1„L7z,
(if known) (6)
Original Date of Issue 02/26/2019 , _
(if known) (7)
APPROvr;
Reason for original issue of Warrant/Check (8): MAU 103
Payroll DATE
LI For Services or Goods furnished
MARICOPA COLN-,
ill Other:
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

Warrant header,
General Posting
arrant number: 370146676 In ci:
Holder: MCTONOON107 In.-xice date:
date: 2.126/2019 Pd d.3te.!
Stopped re pay !;€i-lt (late:
thy:
Agency details
1-ib 28
fcr positive pay:
;igen( ) Icy,
Locke( I fOfftiIE P.1:1:urnber:
Registered ;:gency sub hi n(L
Date registered: 4,ge- ncy dept nutm
riter'est: 0
flHd:ntefest. 1 t 0.00000
Warrant Lines
Amount Payee Account
594,67 PITTERSON, RAYMOND