101018 DUPLICATE WARRANTS 2.PDF

Maricopa County — Formal (2018-10-10)

View PDF Item 99 Meeting page

Extracted text (via pymupdf_layout) 2782 characters
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: 9/11/2018
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.
#95 Queen Creek Unified Al Golf Carts $518.68
RECEIVED
SEP 13 2018
MARICOPA COUNTY
CLERK BOAT OF SUPERVISORS
/70

9/4/2018 Al Golf Carts Affidavit.jpg
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.
1° \11.rneZSrInt (1), being first sworn, upon oath deposes and says:
On or about (_0\6V (date)(2) a warrant/check was issued to the
above named perso /e tity 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 $ \ gtolc .(3)
Wro (4)
2 Sut
(5) :ribed and sworn to before me this day of 20_bL_ ?'
1
)1t 0 ICLe it /1_0-Ma 4--
1\ Will 11111[11C
DORIS DOERNEMAN
Noun polio- SW of Arizona
My commission expires: MARICOPA COUNTY
JJLt/I1 (9,1 J09 My Commission Expires (seal)
May 1,2021
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 3()D00 4 5'173
(if known) (6)
Original Date of Issue
(if known) (7) LAS VZ
APPROVED
Reason for original issue of Warrant/Check (8):
0 Payroll DA-A_ ejt1
For Services or Goods furnished
0 Other: CL 771K ROARD OF SUPERVISORS
' —nijRTY
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
https://mail.google.com/mail/u/0/#inbox/FMfcgxvzKQgDgPXzwVPtzsfCDNWPm 1CM?projector= l&messagePartld=0.2 1/1