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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: 9/7/2018 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. #214 Tolleson Union Johnstone Supply $514.13 #60 Higley Unified Zachary A Markee $188.46 RECEIVED SEP 11 2018 IVIARICOPA COUNTY CLERK BOARD OF SUPERVISORS //6 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. Johnstone Supply (1), being first sworn, upon oath deposes and says: Name/Claimant On or about August 2, 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 $ 514.13 .( 3) Signed (4) (5) Subscribed and sworn to before me this 3/ day of 20,1 S NOTARY PUBLIC CONNIE KOVAL NOTARY PUBLIC STATE OF NEVADA My commission expires: My Commissio Expires: 09-20-21 , < , Certificate No: 17-3803-1 (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) 21475030113700068256 , .,_, %,1/3700068256 Original (if Date known) of (7) Issue 8/2/18 I A 7!PP OVEi Reason for original issue of Warrant/Check (8): 111 Payroll CLERK, BOARD OF SUPERVISORS For Services or Goods furnished MARICOPA COUNTY *I Other: LOST IN MAIL S:\PROCESSES\Warrants - Duplicate or Stale\02 Forrns\Schools \Schools-Warrants Checks notice of claim.doc Revised June 2015 A.R.S. 11-632 & 15-999 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. ZACHARY ALLEN MARKEE (1), being first sworn, upon oath deposes and says: Name/Claimant On or about d,;2 (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 $ 188.46 .(3 ) Signed: (4) (5) Subscribed and sworn to before me this (Cf/6 day of .5e,04-y7ber,20 . NOTArtY PUBLIC LYNETTE STEWART j My co7is7 expires: ;. Notary Public - State of Arizona MARICOPA COUNTY : • t My Comm, Expires Sept, 17, 2020 ! (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 Number 60565797 /1,7006 7-C ,27---- (if known) (6) Original Date of Issue 08/28/2018 (if known) (7) Reason for original issue of Warrant/Check (8): a Payroll El For Services or Goods furnished CLERK, MARICOPA BOARD OF cot SUPERVI:,,_.; INTY LI Other: S: \PROCESSES \Warrants - Duplicate or Stale \02 Forms\Schools\Schools-Warrants Checks notice of claim.doc Revised June 2015 A.R.S. 11-632 & 15-999