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INTEROFFICE MEMORANDUM Maricopa County Education Service Agency (aka Maricopa County Superintendent of Schools Office) TO: CLERK OF THE BOARD FROM: Terri Ysaguirre SUBJECT: Affidavits —fttplacement of Lost Warrants DATE: 2/16/2018 (49c-ontl) 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. #5 Isaac District Office Depot $40,449.12 #216 Agua Fria Union Meza, Alejandro $50.00 uu,v citale 2 -ig I qtz_ lirta(Li \JOtAL61 mcEsA Schools Affidavit/Claim Form Application for a Duplicate Warrant/Cheek (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. Cc" Par (1), being first sworn, upon oath deposes and says: a e I iman On or about -111/4 U-S+ I Dal (date)(2) a warrant/check was issued to the above named pers /entity 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, 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 $ 1-10) LI 4 CI I — (3) Signed: (4) SY Nit, Notary Public State of Florkia Stefanny Polley 11 My Commission FF 975797 or I LW- Expires 03/28/2020 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 1 of known) (6) 0 0 1 Original Date of Issue I if known 7 idiAl 6 Reason for original issue of Warrant/Check (8): 0 Payroll APPROVED 0 For Services or Goods furnished • DAT fYi<ther: OcS+- C-11\e–CAS ;LERK. - BOARD OF SUPERVISORS MAHiL;Or'AC tAsiTV SAPROCESSES\Warrants Dupllcate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claindoc Revlsed June 2015 A.R.S, 11-632 & 15-999