062718 DUPLICATE WARRANTS 5.PDF

RECEIVED
JUN 4 2018
INTEROFFICE MEMORANDUM MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS
Iff--1
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: 6/4/2018
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.
#201 Buckeye Union Alpha Media $576.00**
**Note
This Vendor was having difficulties with the District in regards to the Vendor Letter being sent
over. See email attached.
Today, I received the Vendor Letter. I hope it works!

Schools Affidavit/Claim Form
Application for a Duplicate Warrant/Check (definitions are on page 2)
STATE OF ARIZONA NoIdic* Note: Numbers on this form correspond to numbers on the
COUNTY OF MARICCOA Instruction sheet which is page 2 of this form.
v erital
Alpha Media (1), being first sworn, upon oath deposes and says:
Namerummant
On or about September 14, 2017 (date)(2) a warrant/check was issued to the
above named person/entity in the amount as slated 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, gx 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 ipge;I to him/her in the sum of $ 576.00 .(3)
(5) Subscribed and sworn to before me this ' day of et,1-1441 2010 .
2
NOTARY PUBLIC Notary Zbt7- State of New G York
No. 01R06219871
Mv mission expires: Qualified In New York County
( My Commission Expirrts Apr, 0, R010 (seal)
cr
Note: Please attach a copy of the warranVcheck if available and/or any other
evidence that a warrant/check was originally Issued.
Warrant/Check Number 480024714
Of known) (6) A re ict..,
Original Date of Issue 09114/2017 ,eli- If il E.3
(if known) (7) A II lia 71110
Reason for original issue of Warrant/Check (8):
0 Payroll CLERK, BOARD OF SUPERVISORS
MARICOPA COUNTY
M For Services or Goods furnished INV 2708
0 Other: INV 2708
SAPROCESSES1Warrants - Duplicate or Stale\02 Forms‘SchooLASchools-Warrants Checks notice of dalm,doc
Revised June 2015 A.R.S. 11-632 & 15-999