061318 DUPLICATE WARRANT 8.PDF

RECEIVED
MAY 22
INTEROFFICE MEMORANDUM MARICOPA COUNTY
AA. t VISORS
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: 5/18/2018 (#2)
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.
#45 Fowler Elementary Uline $291.30
#5 Isaac Elementary Transcendent Solutions Inc. $11,628.00 **
**Note
This Vendor is a One-Man Consultant Company being used at various schools. The signature on
his Vendor Letter is his electronic signature versus his live signature on the Affidavit.
Please let me know if you'd like a new Vendor Letter.

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
;OUNTY OF tvlARICOPA Instruction sheet which is page 2 of this form.
"LSAI /11-871.1 141"liC(1): being first sworn, upon oath deposes and says:
ame/Glaimar t
On or about ---1 , ,, II (date)(2) a warrant/check was issued to the
above named pdr onigntity 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-as 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
be issu to him/herAi the sum of $ 02CII. ?)D. (3)
(4)
(5) Subscribed and sworn to before me this day of 2O)
6:1
NOTARY PUBLIC
"OFFICIAL SEAL"
Myi,c?mrni.sion expires; Matthew S Mezger Jr
-5-// Notary Public, State of Illinois (seal)
My CommiSSion Expires 9/25/2niq
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
--nrir- i . ,, ,1 .
Warrant/Check Number L113 00 USC)1LP
(if known) (6)
Original Date of Issue i (--- .°,11pqr/ llwirfro-,-,
__V knowillgi_ - -- I 1 2-0 kcS k.—......"
CLERK, BOARD OF SUPERVISORS
Reason for original issue of Warrant/Check (8): MARICOPA COUNTY
0 Payroll
\p-4, For Services or Goods furnished
0 Other:
SAPROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools \Schools-Warrants Checks notice of dalm.doc A.R.S. 11-632 & 15-999
Revised June 2015

.Schoogs ki7ficlautit/Cllailm Rdnan
Appncation kw a Ougicate bAdarranitiCheck (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.
)1A-nCelf)C 1t M(it,41' being first sworn, upon oath deposes and says:
me/Glairnant
On or about ( 1\ (ty 1 )01b (date)(2) a warrant/check was issued to the
above named person/ nti 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 $ WI .(3)
Signed: (4)
(5) Subscribed and sworn to before me this / to day of iiirkg 201P .
ÔFFICLAL SEAL 1
MARY LOU M. MARTINEZ i
My commission expires: Notary Public - State ofArizona
MARICOPA COUNTY I
My Comm. Expires June 1, 2021! (seal)
Mote: 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) ;r7 1I',1AY 2 9 201
DAT
Original Date of Issue
(if known) (7)
K, BOA= IS-Ven*
Reason for original issue of Warrant/Check (8): MARICOPA COUNTY
El Payroll
El For Services or Goods furnished
er: -)S" Che_CK— Nies -V ' '2\ CW-'12_62
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc
Revised June 2015 A.R.S. 11-612 & 15 -999