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INTEROFFICE MEMORANDUM
Waricopa County School -Superintendent's Office
TO: CLERX OE THE WOilki) RECEIVED
FROM: 5KilTie Thompson DEC 0 3 2018
SUBJECT: Affidavits
MARICOPA COUNTY
DATE: 12/3/2018 CLERK BOARD OF SUPERVISORS
(Prease find attached I AffidavittArotice of Craim(s)for Cost warrants for inc fusion on
the ne.t avada6Ce Ooard agenda
The attached item(s) have 6een researched to ensure that the warrant(s) in
question have not 6een cashed or previous()) re-issued
The oi-iginaCwarrant(s) have had a stop payment done.
If you have any questions, please contact %fate Thompson at 372-1244 or via e-mail at
mthompson@mcesa.maricopa.gov . Approved Affidavits may he routed hack to the
Superintendent of School finance (Division at 4041 N. Central-Avenue #1200, ( 12 th
'Floor) Thankyou.
#201 VOCKETE VNION - JOE WILLIAWIS $100.00
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.
Joe Williams (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about Aug 16, 2018 (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 i the sum of $ 100.00 .(3)
Signed: (4)
(5) Subscribed and sworn to before me this &' L{1— day of i)C17414A 20 /y .
7ThrrK
LAg4
NOTARY PUBLIC LESLIE STIR NM
Nota:y P.bLc - kzor
Mar-cope Cc..r.ty
My commission expires: My Comm. Expires Dec 27. 2021
D tc_ . 7, (72/679,i (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 3700072610/201626989
(if known) (6)
Original Date of Issue 08/16/2018
(if known) (7) 191) LI in of
Reason for original issue of Warrant/Check (8):
Payroll CLERK, BOARD OF SUPERVISORS
MARICOPA COUNTY
For Services or Goods furnished
LI 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