Extracted text (via pymupdf_layout)
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REQEIVED
MAY 2 4 2018
INTEROFFICE MEMORANDUM
ittefit UNTY
Maricopa County Education Service Agency (aka CLERK BOARD OF SUPERVISORS
Maricopa County Superintendent of Schools Office)
TO: CLERK OF THE BOARD
FROM: Terri Ysaguirre
SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 5/22/2018 (#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.
#214 Tolleson Union AZ Association of Student Councils $1,300.00
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.
Arizona Associiation of Student Councils (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about December 12, 2017 (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 birniKer in p60 sum of $ 1,300.00 .(3)
Signed: (4)
(5) Subscribed and sworn to before me this 3 day of MPtqC-4 20 IS .
C
NOTARY PUBLIC
TYSON OLIVER
My commission expires: Notary Pubic - $tale of Arizona
472L-{ /262_1 My MARICOPA Commission COUNTY Explisa (seal)
May 24, 2021
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 480053500/214744390 APPR 0VE
(if known) (6) ycp ADAM e 'fr;
Original Date of Issue 12/12/17 'A , • - / ifroin
(if known) (7)
CLERK, BOARD OF SUPERVISORS
Reason for original issue of Warrant/Check (8): MARICOPA COUNTY
El Payroll
El For Services or Goods furnished
Other: Registration for Student Council Conference
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