082918 DUPLICATE WARRANTS 10.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: 8/13/2018
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
terriNsaguirre@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.
#59 Laveen Elementary Erin Patton $1,048.80
#98 Fountain Hills Unified CenturyLink $770.13
RECEIVED
AUG 14 2018
MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS
/

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: Ig Duplicate or 0 Stale-Dated (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.
Erin Patton (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 08/03/2018 (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 issyl,el to him/her in the sum of $ 1,048.80 43)
Signed: (4)
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
(5) Subscribed and sworn to before me this day of AZT,64 - 20151 .
14.d
NOTARY PUBLIC ) How( public . stole KING of Anions
NoY MARICOPACOUNTY
mv common ExPifes
My commission expires: ' October 3, 2020
(seal)
Warrant/Check Number 3700067127
(if known) (6)
Original Date of Issue 08/03/2018 APPROVED
(if known) (7) t. I
Reason for original issue of Warrant/Check (8):
I! Payroll CLERK, BOARD OF SUPERVISORS
MARICOPA COUNTY
0 For Services or Goods furnished
El Treasurer's refund/payment
111 Other:
5: \PROCESSES \Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc
Revised April 2015 A.R.S. 11-632 & 11-644

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: Duplicate or El Stale-Dated (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), being first sworn, upon oath deposes and says:
On or about 0,W/3/Z° 03- (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 $ 770./3 .(3)
Signed: (4)
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was or ,dhally issued.
(5)iubs Icribed . ancl/No o befor qI1111 wawa 1'*-41w!
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Notary Public
My co mision expires: State of North Dakota
My Commission Expires February 1, 2022
9 (seal)
Warrant/Check Number
(If known) (6) 370000G5-yo
Original Date of Issue
(if known) (7) fi 3/ t-1- /g
Reason for original issue of Warrant/Check (8):
0 Payroll
0 For Services or Goods furnished etEftre7BeerRe-e.F SUPERVISORS
MARICOPA COUNTY
0 Treasurer's refund/payment
X Other: Lo ‘yr IA) 1—Hs--- fr7A--7
S:\PROCESSES\Warrants - Duplicate or Stale \02 Forms\Warrants Checks notice of claim - Copy.doc
Revised April 2015 A.R.S. 11-632 & 11-644