011619 DUPLICATE WARRANTS 11.PDF

INTEROFFICE MEMORANDUM
Maricopa County Education Service Agency (aka
Maricopa County Superintendent of Schools Office)
TO: CLERK OF THE BOARD
FROM: Terri Ysaguirre
SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 12/13/2018
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.
#44 Avondale Elementary The Clubhouse $2,176.00
RECEIVED
DEC 14 2018
MAP IGO PA CCIL\ITY
CLERK BOARD OF JEH VISORS

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 MARICOIDA Instruction sheet which Is page 2 of this form.
1 h 12, L L u-ri Se.- 1 irw vet P---1 I 06 (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 113- t2 Lt O 1 (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,l‘issued Rhimitier ium of $ cs, Le • DC1 43)
Signed: (4)
(5) Suliscribed afid sworn to before me this day of 20 ,
Ikg !Lc, e
NOTARY PUBLIC COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL
My commission expires: STEPHANIE MILLS, NOTARY PUBLIC
CITY OF WEST CHESTER, CHESTER COUNTY, eal)
MY COMMISSION EXPIRES SEPTEMBER 3, 2019
Note: Please attach a copy of the warranVcheck if available and/or any other
evidence that a warrant/check was originally issued,
Warrant/Check Number A / i ,
(if known) (6) -orthotb1"O4)r.). / Lri-ricpLI- iltt, g..
Original Date of Issue
(If known) (7)
Reason for original issue of Warrant/Check (8):
0 Payroll APPROVED
IVFor Services or Goods furnished V\16t61-1-13
LI Other:
MARICOPA COUNT'.
SAPROCESSES\Warrants - Duplicate or Stale \02 Forms\Schools\Schools-Warrants Checks notice of clalm.doc
Revised line 2015 A.R.S. 11-632 & 15-999