061318 STALE DATED WARRANT 1.PDF

INTEROFFICE MEMORANDUM
Maricopa County Education Service Agency (aka
Maricopa County Superintendent of Schools Office) RECEIVED
MAY 25 2018
TO: CLERK OF THE BOARD
MARICORA COUNTY
FROM: Terri Ysaguirre CLERK BOARD OJJ.
SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 5/24/2018
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.
#59 Laveen Elementary Theresa Frances Dowling $2,636.26
#59 Laveen Elementary Theresa Frances Dowling $1,159.51

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: 1 Duplicate or El Stale-Dated (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.
Theresa Dowling (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about May 25, 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 him/her in the sum of $ Two Thousand six hundred thirty-six and 261100 dollars .(3)
Signed: (4)
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
(5) Subscribed and sworn to before me this day of -P/a,g,_ 20LE.
NOTARY PUBLIC
My commission expires:
- (seal)
Warrant/Check Number 170073604
(if known) (6)
Original Date of Issue May 25, 2017
(if known) (7)
Reason for original issue of Warrant/Check (8):
*I Payroll
D For Services or Goods furnished
0 Treasurer's refund/payment
El Other:
SAPROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc
Revised April 2015 A.RS. 11-632 f§. 11-644

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: RI Duplicate or 1:1 Stale-Dated (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.
Theresa Dowling (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about May 25, 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 him/her in the sum of $ One thousand one hundred fifty-nine and 51/100 dollars f")\
Signed: . •••/P1-(_,,I,./,t_ (J'Af/n) (4)
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued
(5) Subscribed and sworn to before me this /. -/-12 day of , Le*, 20 / ,K' .
Pd-'44/791K Goyaz
NOTARY:OUBLIC
My commission expires:
(seal)
Warrant/Check Number 180006594
(if known) (6)
Original Date of Issue August 4, 2017
(if known) (7)_ _
Reason for original issue of Warrant/Check (8):
FM Payroll
0 For Services or Goods furnished
D Treasurer's refund/payment
0 Other:
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc
Revised April 2015 A.R.S. 11-632 &.11-644