110718 DUPLICATE WARRANTS 6

Maricopa County — Formal (2018-11-07)

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INTEROFFICE MEMORANDUM
Maricopa County Education Service Agency (aka
Maricopa County Superintendent of Schools Office)
RECEIVED
TO: CLERK OF THE BOARD OCT 1 6 2018
FROM: Terri Ysaguirre MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS
SUBJECT: Affidavits — Replacement of Lost Warrants
I/6
DATE: 10/15/2018
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@nncesa.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.
#79 Litchfield Elementary Nutri-Link Technologies Inc $1,785.00

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.
Nutri-Link Technologies, Inc. (1), being first sworn, upon oath deposes and says:
—1ITii7-7 ne claimant
On or about July 17, 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 apd-OWipg, the applicant requests that a replacement
warranticheck be sued,tolA/17,in t*Sunn of $ 1,785 -00 .0)
Signed: (4)
(5) Subscribed and sworn to before me this day of
de-W./4)6a'
NOTARY PU C ./NOTARY *
:1.PUI3LC
My commission expires: EXPIRES
-vs?.
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 3700061267/79722234
(if known) (6)
Original Date of Issue 07/17/18
(If known) (7)
Reason for original issue of Warrant/Check (8):
El Payroll CLER-k. BO ARD M
MARICOPA COUNTY
r* For Services or Goods furnished
ED Other:
S: \PROCESSES \Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc A.R.S. 11-632 81. 15-999
Revised June 2015