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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: 10/3/2018 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 terrLysaguirre@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. #45 Fowler Elementary Collaborative Learning $1,965.60 RECEIVED OCT 0 4 2018 MAR1COPA COUNTY CLERK BOARD OF SUPERVISORS Schools Affidavit/Claim Form Application for a Duplicate Warrant/Check (definitions are on page 2) Note: Numbers on this form correspond to numbers -on the STATE OF ARIZONA Instruction sheet which is page 2 of this form. COLT OF IORIC PA c k- (2/// ,i,i7ve cle, SS r--" 11) (1), being first sworn, upon oath deposes and says: Name/Claimant jter- .2—J1 2jdi, (date)(2) a warrant/check was issued to the On or about rsonientityn the amount as stated below. Such warrant/check was above named p subsequently inadvertently lost or destroyed and there is either never received or was being found or presented for payment, or it was not no reasonable probability of its presented for payment within one year after the date of issuance. Therefore, under penalty of peijury, 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 $ ‘57, .(3) C}--,.1-21"4./ (4) Signed: nd sworn to; b , fore me this li day of W 20 (r . ) ., _ L..-- L....- ,.... DEANNA All Commission # 2122986 Notary Public - California I My aimmission expires: Alameda County (seal) My Corm. Expires _Al 11,2014 ,i214 D 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 115 3,3 55 (if known) (6) Original Date of Issue Oil Li 1201 . I -APPROVE (if known)_(Z Reason for original issue of Warrant/Check (8): Payroll CLERK, BOARD OF SUPERVISORS 54; For Services or Goods furnished ND' El Other: SAPROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of daim.doc A.R.S. 11-632 & 15-999 Revised June 2015