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RECEIVED APR 1 8 2018 INTEROFFICE MEMORANDUM CLERK MARICOPA BOARD OF COUNTY SUPERVISORS gliaricopa County SchoolSuperintendent's Office TO: CLERK OE TOE 00A RD FROM: Iliffie Thompson SUBJECT: Affidavits DATE: 4/17/2018 Tase find attached 1 Affidavit/Arotice of Claim(s)for Cost warrants for inclusion on the next available Ooard agenda The attached item(s) have 6een researched to ensure that the warrant(s) in question have not been cashed - or previously re-issued The original-warrant(s) have had a stop payment done. If you have any questions, please contact Willie Thompson at 372-1244 or via e-mail at mthompson@mcesa.maricopa.gov . Approved Affidavits may be routed back to the Superintendent of School - finance Division at 4041 N. CentraCAvenue #1200, ( 12 th Efoor) Thankyou. #59 LA VEEN. STO 51//91/A RA171 .9VIAN - $243.36 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: RI Duplicate or 0 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. Shamimara Rahman (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 03/29/2018 (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 $ 243.36 .(3) Signed: c171/1arvi'‘ -RalvokcurI (4) 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 3700010080 (if known) (6) 'P. Original Date of Issue (if known) (7) Reason for original issue of Warrant/Check (8): It Payroll RIK ; BOARD OF SU ,=ECEI S MARICOPACC O For Services or Goods furnished O Treasurer's refund/payment O 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