062718 DUPLICATE WARRANTS 7.PDF

ECU
JUN - 7 21118
INTEROFFICE MEMORANDUM MAFIICO,a, COUNTY
CLERK BOARD OF SUPERVISORS
Maricopa County Education Service Agency (aka OLI
Maricopa County Superintendent of Schools Office)
TO: CLERK OF THE BOARD
FROM: Terri Ysaguirre
SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 6/7/2018
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.
#09 Wickenburg Unified Marie Payne $40.05
#68 Alhambra Elementary Michelle M Schilling $1,084.18
#68 Alhambra Elementary Michelle M Schilling $7,055.12

WICKENBURG UNIFIED SCHOOL DISTRICT NO. 9
40 W. Yavapai, Wickenburg AZ 85390
Phone (928) 668-5350 Fax (928) 668-5390
(1-IA MPIONS
- FOR -
CLERK. BOARD OF:SUPERVISORS CHILDREN
MARICOPA COUNTY
AFFIDAVIT
, being first duly sworn, upon oath deposes and says:
That on the day of r 20U, he presented to Wickenburg Unified School District #9
Maricopa County, for payment, a claim for services rendered or supplies furnished during the
Th
month of A-RAI6i-- , said claim being the sum of 4-uA 0 +° In)
Dollars ($ 1--10 ) in payment of which the Superintendent of Schools caused Warrant #
S 0 Dl 7/4 to be issued on g- , 20 11 , drawn on the0 0 I fund of
Wickenburg Unified School District #9 of Maricopa County, Arizona.
Affiant further says that although he was informed and believes that the above mentioned
warrant was regularly issued, the same has never been received, or has been lost.
Wherefore, affiant prays that the Board of Supervisors order and the Superintendent of schools
issue to him a duplicate of said Warrant # 1-1 bb 11461 in the sum of $ Lib
.
Signature:
Subscribed and sworn before me this day of , 208
AM. AAI‘ ' ki4L.I.A•b°
Notary gnature Colin ission Expiration Date

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.
MICHELLE MARIE SCHILLING (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 62-51- 48--- 5b47qciate)(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 $ 1,084.18 .( 3 )
Signed: (4)
(5) Subscribed Subscribed nd yvorn to me this z -''fi/ , day of 0 20
• -____'—
NOTARY PUBLIC (
MONICA LOPEZ
My commission expires: Notary Put:Tic-Static/Arizona
7/ ti (6 My MARICOPA Convn. &Tires COU Ity 14;20/8 I
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
(if known) (6) 31
Original Date of Issue 05-22-2018
(if known) (7) , n if TrA 4,1n 7,1 if-, Ilt 9 Tra 'Via
Reason for original issue of Warrant/Check (8):
Payroll
El For Services or Goods furnished CLERK, MArlICOr't BOARD OT' ,--"ERVISORS
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.
MICHELLE MARIE SCHILLING (1), being first sworn, upon oath deposes and sa ys:
Name/Claimant
On or about —/g (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 subse quently inadvertently lost or destroyed and there is
no reasonable probability of its bein g found or presented for pa yment, or it was not
presented for pa yment within one year after the date of issuance.
Therefore, under penalt y of perjury, claimant hereby affirms that this claim is correct
and the amount shown is due and owin g, and the applicant requests that a replacement
warrant/check be issued to him/her in the sum of $ 7,055.12 .(3)
Signed: Kz2„.aa (4)
(5) Subscribed a d sLJ.tb foe -me this 6 f-ifk day of J of\-) '2-- 20 I 8 .
NOTARY BLIC
OFFICIAL SEAL
My commission expires: Noisy MONICA Pub0c • State LOPEZ of Arizona 1 •
-7 1 t-r ( 6 My MARICOPA COMM Expires COUNT( 14, 2018 sea I I)
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 ,--f 000
(if know w n) (6)
Original Date of Issue 5-22-1 8
(if known) (7)
Reason for ori ginal issue of Warrant/Check (8):
Payroll
0 For Services or Goods furnished
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