091918 DUPLICATE WARRANTS 8.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: 8/31/2018
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.
#402 West - MEC IDEXX Distribution Inc. $140.74
RECEIVED
AUG 31 2018
MAR ICOPA 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.
OtZtf' 'CR4rit,(13:TICyrbeing first sworn, upon oath deposes and says:
---j ne reant rn'
On or about \---‘ct a)), Rot% (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
Ho • -q-4
warrant/check be issued to him/her in the sum of $ .(3)
Signed: el al--/ Z?_-) (4)
(5) Subscribed and sworn to before me this " day of -4- 20
NOTARY PUBLIC ' LINDSEY CURLESS
NOTARY PUBLIC - MAINE
My commission expires: MY COMMISSION EXPIRES
_ FEBRUARY 09, 2020Seal)
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 3-3._Doc3 g t4 9 APPR"
(if known) (6) S.E 0 4 20
Original Date of Issue D 5 _ .,
(if known) (7)
Reason for original issue of Warrant/Check (8): CLERK, MARICOPA BOARD OF COUNTY SUPERVISORS
0 Payroll
5-For Services or Goods furnished c_QA S+1
0 Other:
S:\PROCESSES\Warrants DuplIczte or Stale= Forms\ Schools\Schools-Warrants Checks notice of cialm.doc A.R.S. 11-632 et 15-999
Revised June 2015