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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: 11/8/2018 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 Photomart Corp $554.64 RECEIVED NOV 0 8 MARKX CLERK BOAf!'i ' 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. (110-611-vo./.41 (.blip - (17 ‘.:)01,1.6*ep5(1), being first sworn, upon oath deposes and says: Name/Claimant On or about VI- eg.n - t4,1 0 l (1 (date)(2) a warrant/theck 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/che4 be issued hin)/her in the sum of $ 6646 .(3) Signed: E •P (4) (5) Subscribed and sworn to before me thiS3) day of CC4è17( 20\ E) . NOTARPUBLIC r15 , 1AT Uto) Notary Public BeT Martoopa County, Arizona M6T In My Comm- Expires 03-31-19 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 (If known) Number (6) '0 A 1 600 al L'zt, 1 '1 /L11-1'9 te /-1"' 1 LP Original Date of Issue (If known) (7) &I - :1-.ca4C)n Reason for original issue of Warrant/Check (8): 0 Payroll NI/For Services or Goods furnished PiiisrJrax , cArA a_ ,5 Z/10415 lAther: OS-c V.4 SAPROCESSEMarrants - Duplicate or Stale \02 Forms\Schools\Schools-Warrants Checks notice of claindoc Revised June 2015 A.R.S. 11-632 t3i 15-999 CLERK, BOARD OF SUPERVISORS MARiCOPA COUNTY