091918 DUPLICATE WARRANTS 7.PDF

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: 8/24/2018
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.
#95 Queen Creek Unified Irma Moreno $490.66
RECEIVED
AUG 2 7
MARICOPA COuNTY
CLERK BOARD OF SUPERVISORS

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.
M1-\ DS2-1I.} (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about S1 14 2c:A (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 $ 4-9 0 Iac) .(3)
Signed: kk,,d11),y) a., _..,4104C-176 (4)
(5) Subscribed and sworn to befcrry me this 490V6giday of 20 /X.
Y MIMIC
JENNIFER D. YOUNG
ommission e ires: Notary MARICOPA Pui* - State COUNTY of Arizona
k Ht io-oaa- My Commission Expires (seal)
April 11, 2022
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 / 700 7051-N-
(if known) (6) 9 5(etoC 3i—
Original (if Date known) of (7) Issue --) 1 I 4 I Z k ___ _
A Ira 1m % "r) :- \ i •-I 1 ‘f ' • I
n for original issue of Warrant/Check (8):
Re5t Payroll
ID For Services or Goods furnished CLERK, BOARD OF Si.JERVISORS
r$. 5,7117771177770177177
D Other:
S:\PROCESSES\Warrants - Duplicate or Stale \02 Forms\Schools\Schools-Warrants Checks notice of claim.doc
Revised June 2015 I A.R.S. 11-632 & 15-999