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INTEROFFICE MEMORANDUM liaricopa County School-Superintendent's Office TO: CLERK OE TYPE 00ARD FROM: Wale clfi ompson RECEIVED SUBJECT: Affidavits MAR 1 4 2019 DATE: 3/13/2019 MARICOPA c'OUNTY CLERK BOARD OF SUPERVISORS Please find attached 1 Affidavit/Wotice of Cfctim(s)for lost 'warrants for inclusion on the next avairaffe Ooard agenda -\1 The attached item(s) have 6een researched to ensure that the warrant(s) in question have not 6een 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@mcesa.maricopa,gov. Approved Affidavits may be routed back to the Superintendent of School - Finance Division at 4041 X Central- Avenue #1200, ( 12 th Eloor) Thankyou. # 214 ToCson 'Union Gerardo Palomino $345.20 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. tagivtiem (1), being first sworn, upon oath deposes and says: Name /claimant On or about ,912, 2119 (date)(2) a warrant/check was issued to the above named person/enity 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 $ .(3) Signed: (4) (5) Subscribed and sworn to before me this day of 44 • 20 /9. NOTARY PUBLIC JOYCE C. COUNCIL Notary PobrE - State ot Arizona My commission expires: MARICOPA COUNTY My Commission Expires itak) 10z)A/ September 11, 2021 (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 (if known) (6) Original Date of Issue (if known) (7) 021°112 it Reasonior original issue of Warrant/Check (8): MAII 1 5 2019 M4ayroll 0 For Services or Goods furnished rPzaig4' D 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 _1`i;L! I Warrant header General Posting Warrant number: 3700147051 Invoice: Holder: MCT0000000107 Invoice date: Issued date: 212612019 12:00:00 am Paid date: Status: Stopped Positive pay sent date: 2/2212019 02:45:47 pm Exception flag: Agency details E ceptirn rear:cm: None Agenc :, number: 27 Queued for positive pay: Agency claim number: Agency low orig: ed for reconcile: Agency PO number: Registered Agency sub fund: Date registered: Agency dept num: No of days interest: 0 A.nnual interest rate: 0.00000 Warrant Lines Li Amount Payee Account 345,201 PALOMINO, GERARDO