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RECEIVED `17:7=cri=lt 1 8 INTEROFFICE MEMORANDUM MARICOPA COUNTY CLERK=SCVMOTTFMPERVISORS 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: 5/23/2018 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. #79 Litchfield Elementary Health Equity $9,170.90 #401 EVIT Platinum Educational Groups $500.00 #60 Higley Unified Kathy Dorer $234.21 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, Health Equity (1), being first sworn, upon oath deposes and says: On or about 3 (date)(2) a warrant/check was Issued to the above named person/ tity i 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, gi 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 slim Of $ 9,170.90 .(3) (4) scribed and sworn to b pre me this _MTh day of 2O, 1 . AA. CARTER HOMY PUPLIC•SIAIE OF UTAH My co is expires: COMMISSIONd 692338 it COMM, EXP. 11-03-2020 (seal) Note: Please attach a copy of the warrant/check If available and/or any other evidence that a warrant/check was originally Issued. rWarrant/Check Number ,3700007913 known) ow n 6 Original Date of Issue 3/22/18 (If known) (7) Reason for original issue of Warrant/Check (8): CLERK, BOARD OF SUPERVISORS Payroll MARiCOPA COUNTY El For Services or Goods furnished El Other: 5: \PROCESSES\Worfartts - Duplicate Or Stale \02 rorms\SchoolASChools-Warrants Checks notice of clAirn,doc Revised )urie 2015 A.R.S. 11-632 Ai 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. Wh y\ tiorvOrago (1), being first sworn, upon oath deposes and says: me/Ulaiman On or about q1101got3 (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/checbe issued tril him/her in the sum of $ 5_00,00 .(3) Signed: (4) (5) Subseribed and sworn to before me this / 7 day of ItYleLla_ 0/e4i NOTARitOPUBLIC Angela R. Vanzytveld Notary Public - Michigan My commission expires: Ottawa County My Commission Expires /1/20 3 (seal) Acting in the County of 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 VID6Omoi A 17 P OvLia (If known) (6) AY J 2018 Original Date of Issue 111101X/1g DAT (If knowni(Z) Reason for original issue of Warrant/Check (8): MARICOPA COUNTY S 0 Payroll 0 For Services or Goods furnished ZOther: na4 1 1-046.4 S'i Llc ne re.0 SAPROCESSESMarrants • Duplicate or Stale\02 Forms \Schools\Schools-Warrants Checks notice of clalm,doc Revised June 2015 A.R.S. 11-632 & 15-999 Scanned with CamScanner 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. Kathy Dorer (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 5) )1 (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 $ 234.21 .(3) Signed: (4) scribed and sworn to before me this day of /nag_ 20 4 °FPIDAL SEAL LYNETTE STEWART AriZON1 My,c9mm7ion expires: i Notary MARICOPACOUNTY Public - State of 1 _ 1 My Comm, Expires Sept. 17, 2020 (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 3700028421 . iY 2 9 7 1 18 if known 6 drrfify s?AiE A Original Date of Issue 05/07/2018 (if known) (7) — — onman OF SI IPPRVISORS MARICOPA COUNTY Reason for original issue of Warrant/Check (8): 0 Payroll For Services or Goods furnished Reimbursement for travel 0 Other: Reimbursement for travel 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