011619 DUPLICATE WARRANTS 18.PDF

INTEROFFICE MEMORANDUM
_
Maricopa County Education Service Agency (aka
Maricopa County Superintendent of Schools Office) RECEIVED
DEC 2 1 20 18
TO: CLERK OF THE BOARD MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS
FROM: Terri Ysaguirre
SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 12/20/2018 (#2)
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 Joshua Bryan Jarrell $1,852.26
#65 Littleton Elementary Valley Schools Benefits Trust $16,736.85

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: RI Duplicate or 0 Stale-Dated (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.
Jarrell, Joshua Bryan (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 11/6/2018 (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 in the sum of $ 1,852.26 .(3)
Signed t. (4)
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
(5) Subscribed and sworn to before me this N day of betertNtoef 20 t
\4
W,ervi
ADRIENNE VELTHOVEN
My commission expires: Notary Public, State of Michigan
10 • 1. My Commission County of Expires Washtenaw 1 0-03-2020, (seal)
Acting In the County of1/4.44,,WKINtIkl
Warrant/Check Number 3700105055
(if known) (6)
Original Date of Issue 11/6/2018
(if known) (7) 111 r. ,!•') V E
Reason for original issue of Warrant/Check (8):
III Payroll
O For Services or Goods furnished
O Treasurer's refund/payment
O Other:
SAPROCF_SSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc
Revised April 2015 A.R.S. 11-632 81, 11-644

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: 0 Duplicate or 0 Stale-Dated (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.
14-fie44 Name/Claimant Se-4(0/S 5/np/o9ee-0), being first sworn, upon oath deposes and says:
ne-F-1 Ar 71-ti /—
On or about I>cepriker. /W; ao/ ( ,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 in the sum of $ fie, .( 3)
Signed: " _ (4) (4)
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued,
(5) Subscribed and sworn to before me this day of OZ..Ctellbe R 20 1Y) .
tt, Qt,ukAQ-Lur
NOTARY PUBLIC
My commission expires:
01 / I 20
(seal)
Warrant/Check Number
f if known) (6) Foos-a,30
Original Date of Issue
(if known) (7) 1Q,Haot --/ APPIFIAL
soy !// !3'
R e for original issue of Warrant/Check (8): DA
Payroll
O For Services or Goods furnished CL MARICOPA ARD OF COUNTY SUPE nOH
O Treasurer's refund/payment
O Other:
S:\PROCESSES\Warrants - Duplicate or Stale \02 Forms\Warrants Checks notice of daim - Copy.doc
Revised April 2015 A.R.S. 11-632 & 11-644