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RECEIVED - s- 24.2_01e MAY 1 1 2018 INTEROFFICE MEMORANDUM MARICOPA COUNTY CLERK BOARD OF SUPERVISORS Maricopa County Education Service Agency (aka Maricopa County Superintendent of Schools Office) RECEIVED TO: CLERK OF THE BOARD MAY 21 2018 FROM: Terri Ysaguirre MARICOPA COUNTY CLERK BOARD OF 3UPERVISORS SUBJECT: Affidavits — Replacement of Lost Warrants DATE: 5/10/2018 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.vsaguirre@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 Hoodz of Greater Phoenix & Tucson $1,449.00 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, HOODZ Name/Claimant OF GREATER PHX (1), being first sworn, upon oath deposes and says: On or about 03/1312018 (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 $ 1,449.00 ,(3) (4) (5) Subscribe orn to before me this 24 day of Nip\ 20 Vo . ottttl PO iW,„ NOTARY PU 1114 6' . 1 6 °* My commission, expires: 11) to -r'17::-4 q"fA N: (seal) %ct ) (i"/ - Note: Please attach a copy of the wananVchetielPft4Ilable and/or any other evidence that a warranVcheck was originally issued. Warrant/Check (If known) Number CO 3700004297 AP T5 Y 29 201 Original (if Date known) of (7) Issue MARCH 13, 2018 _.., .1.1i4rammi,wheysir--, AVAPf , / •710/47,"-- ' ‘ Reason for original issue of Warrant/Check (8): CLERK, MARICOPA BOARD OF COUNTY SUPERVISORS 0 Payroll For Services or Goods furnished 0 Other: s:\PROcESSES\Warranis Revised June 2015 - Duplicate or Stale\02 Forms\Schools\Schools-warrants Checks notice of clairn.doc A.R.S. 11-632 & 15-999