062718 DUPLICATE WARRANTS 3.PDF
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RE ''ED MAY 3 1 2018 INTEROFFICE MEMORANDUM MARICOPA COUNTY Maricopa County Education Service Agency (aka CLERK BOARD OF SUPERVISORS Maricopa County Superintendent of Schools Office) TO: CLERK OF THE BOARD FROM: Terri Ysaguirre SUBJECT: Affidavits — Replacement of Lost Warrants DATE: 5/31/2018 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. #25 Liberty Elementary Rogers Gulf Towing $540.00 Schools A •At 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 f oft—b4bIt 040...)I a V.\ 1.-A% t (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 3/Wozoie (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/che fie issued to him/her in the sum of $ S YO. 00 .(3) Signed: (4) (5) Subscribed and sworn to before me this ck I day of xlw 20 I NOTARY PUBLIC RICHARD FULLERTON Notary Public My commission expires: My Commission Expires December 30, 2020 Maricope County (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 3 7000069ei 42 C 0,761V A V E 1.13 (if known) (6) _)-Uu ,„ 0 Original Date ofIssue 3,b0) 4 .4 (If known) (7) " 4 /4414 Reason for original issue of Warrant/Check (8): CLERK, BOARD OF SUEV. 0 Payroll MARiCOPA COUNT'' )41 For Services or Goods furnished PUlifli Sert4i,d 0 Other: SAPROCESSES \Warrants - Duplicate or Stale \02 Forms\ Schools\Schools-Warrants Checks notice of claim.doc Revised June 2015 A.R.S. 11-632 & 15-999