011619 DUPLICATE WARRANTS 20.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: 12/26/2018 (#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.
#5 Isaac Elementary Rian Ashley Woods $1,620.25
RECEIVED
DEC 2 6 2018
MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS
I a

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.
aft- fi. Woods (1), being first sworn, upon oath deposes and says:
On or about antler (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 8 /IOW . IC .(3)
Signed: (4)
(5) Subscribed and sworn to before me this 10194 day of Netfidien/ 20 )0 .
NOTARY PUBLIC
OFFICIAL SEAL.
My commission expires: UNIX LAUER
3 Ac- 19 NOTARY PIA= - STATE OF ILLINOIS (seal)
MY COMPASSION EXPIRES:03/25/19
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) 5700109zo1r
Original Date of Issue ii/i00
(if known) (7)
Reason for original issue of Warrant/Check (8):
X Payroll
K, BOARD OF SUPERVISORS
0 For Services or Goods furnished IiF COPACOUNTY
L-3 Other:
S:\FROCESSES\Wrrn - Dup!icate or Sta'e\02 Formrs ,„SchocIs\Sthoofs-',1:farnn'4 Ctacks notice of ciaim.dco
5 A.R.S _5-999