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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: 8/1/2018 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. #60 Higley Unified DECA Images $356.00 #60 Higley Unified Grainger Parts $182.41 RECEIVED AUG 0 2 2018 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. DECA IMAGES (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 09/29/2017 (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 $ 356.00 .(3) Signed: (4) (5) Subscribed and sworn to before me this Z5- day of Jacj 20 ig NOTARY PUBLIC KRISTEN LAUREN MEGAN JONES NOTARY PUBLIC My commission expires: REG. #7622807 31i 2o 7 MY COMMISSION COMMONWEALTH EXPIRES OF VIRGINIA MAR. 31. 2019 (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 480030141 (if known) (6) I A P P V E It.) Original Date of Issue 09/29/2017 (if known) (7) DAT4 n)S Reason for original issue of Warrant/Check (8): CLERK, BOARD OF SUPERVISORS CI Payroll MARICOPA COUNTY For Services or Goods furnished classroom materials El 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 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. Grainger Parts (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 05/04/2018 (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 $ 182.41 .(3) Signed: law:24k eaddi, 4,22,ede___. (4) (5) Subscribed and sworn to before me this PA day of ja 20 t. KeA.44. NOTARY PUBLIC My coglinisrptxpires: DEBORAH KENSETH NOTARY PUSLie .rzr- 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 3700027270 APPRO V E (if known) (6) Original Date of Issue 05/04/2018 DA a j , , , i As i if known 7 OPPAMMIZI A/Le& CLERK, BOARD OF SUPERVISORS Reason for original issue of Warrant/Check (8): MARICOPA COUNTY LI Payroll For Services or Goods furnished Food Service Supply 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