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RECEIVED MAY 24 21118 INTEROFFICE MEMORANDUM MARicoPA COUNTY Maricopa County Education Service Agency (aka CLERK BOARD OF SUPERVISORS Maricopa County Superintendent of Schools Office) On- TO: CLERK OF THE BOARD FROM: Terri Ysaguirre SUBJECT: Affidavits — Replacement of Lost Warrants DATE: 5/22/2018 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 terrLysaguirre@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. #68 Alhambra Elementary Paige Brill $528.15 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. PAIGE BRILL (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 04 /252018 / (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/ch,,d5be issued to him/her in the sum of $ 528.15 .(3) /-) Signed: (4) (5) Subsgribed ancrisworn to before mthi day of 20 . NOTARY PUBLIC OFFICIAL SEAL My commission expires: Notary HEATHER Public -State L LUSK ofArizona 04/25/2018 MARICOPA COUNTY (seal) My Comm. Expires May15, 2020 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 18102652 M ` 29 MU (if known) (6) • A / / Original Date of Issue 04/25/2018 . 7111rtrt r;'Av (if known) (7) MARICOPA COUNTY Reason for original issue of Warrant/Check (8): II Payroll CI For Services or Goods furnished 18102652 Other: 18102652 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