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RECEIVED APR 1 0 2018 MARICOPA COUNTY CLFRK RflARfl rc SUPERVISORS, INTEROFFICE MEMORANDUM Waricopa County School -Superintendent's Office ED TO: CCERX OF TOE 00.A RD FROM: Miffie Thompson CLERK Li,VISORS SUBJECT: Affidavits DATE: 4/6/2018 Pase find attached 2 AffidavitOotice of Craim(s)for Cost warrants for incrusion on the net avaifa6fe cBoarclagencla The attached item(s) have been researched to ensure that the warrant(s) in question have not 6een cashed or previousCy re-issued (The warrant(s) have had a stop payment done. If you have any questions, prease contact Wiflie Thompson at 372-1244 or via e-mad at mthompson@mcesa.maricopagov. Approved Affidavits may 6e routed 6ack to the Superintendent of School finance Division at 4041 N. Central - Avenue #1200, ( 12 th Efoor) Thankyou. #9 WICKEXOVRG PATRICK3 GROV $387.86 #216 _AGO EVA 914AWKELAqe1tX $490.46 I APPROVED Li PIA CLERK. BOARD OF SUPERVISORS MARICOPA COUNTY WICICENBURG UNIFIED SCHOOL DISTRICT NO. 9 40 W. Yavapai, Wickenburg AZ 85390 Phone (928) 668-5350 Fax (928) 668-5390 111„ clinfriPlosg CHILDR - EN AFFIDA VIT icy eirde, 9 A. being first duly sworn, upon oath deposes and says: That on the 2.111-clay ofJeultiGai 20 he presented to Wickenburg Unified School District #9 IVIaricopa County, for payment, a claim for services rendered or supplies furnished during the month ofiJr)1,aj2L, said claim being the sum of 'Ziihrer n Dollars ($3g7 in payment of which the Superintendent of Schools caused Warrant 4 g00144308 to be issued on , 20 drawn on the fund of Wickenburg Unified School District #9 of Maricopa County, Arizona. Afiiant fiwther says that although he was informed and believes that the above mentioned warrant was regularly issued, the same has never been received, or has been lost, Wherefore, affiant prays that the Board of Supervisors order and the Superintendent of salmis issue to him a duplicate of said Warrant #1 6 Ou ( ) 1.2 ir 0 S t sum of $ 3s Signature: A Subscribed and sworn before me this <---=/ it day of77k22L, 20J5 ' . j2/24-2.Z -Notaty Signature _2 Commission Expiration Date DEBRA A RYAN NOTARY PUBUC, ARIZONA MARICOPA COUNTY Wickenburg Following Notary Unified approval please return original affidavit to; My Common May 30, 2020 Expires School District Accounts Payable 40 W. Yavapai Street Wickenburg, AZ 85340 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. Mark Flatten (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 5/18/2017 V1/47— (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 r in the sum of $490.46 .(3) Signed: (4) (5) Subscribed and s orn to before me this - \ 'day of vz 20 4 111C1)-) NOTARY PUBLIC ANDREA DE LA ROSA r&v Pu5lic - Stste of Arizona M o mission ex MARICOPA COUNTY ; : t.. M y Comm. Expires July 17, 2021 ! (seal) 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 170069910 (if known) (6) APPROVED Original Date of Issue 5/18/2017 DAT51L2thl 91/ict (if known) (7) Reason for original issue of Warrant/Check (8): RIC BOARD OF SUPERVISORS Payroll MARICOPA COUNTv 0 For Services or Goods furnished 0 Other: S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc A.R.S. 11-632 & 15-999 Revised June 2015