042518 DUPLICATE WARRANT 3.PDF

INTEROFFICE MEMORANDUM
Maricopa County Education Service Agency (aka
Maricopa County Superintendent of Schools Office) RECEIVED
MAR 2 3 2018
TO: CLERK OF THE BOARD MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS
FROM: Terri Ysaguirre
416
SUBJECT: Affidavits — Replacement of Lost Warrants /c)
DATE: 3/22/2018
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.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.
#33 Buckeye Elementary The Alliance $1,771.94
#33 Buckeye Elementary The Alliance $8.37
#33 Buckeye Elementary The Alliance $924.04
#33 Buckeye Elementary The Alliance $904.82
#33 Buckeye Elementary The Alliance $2,087.44
#33 Buckeye Elementary The Alliance $4,528.05
#33 Buckeye Elementary The Alliance $4,603.77
#33 Buckeye Elementary The Alliance $4,672.02
#33 Buckeye Elementary The Alliance $4,657.59

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.
Ryan Cole for The Alliance (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about July 4, 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/che k be iss,yecif$ him/her in the sum of $ 1,771.94 .(3)
Signed: (4)
(5) Subscribed and sworn to before me this day of 20 18 .
ef_Z
MARIJON ANDERSON
Notary Public -Arizona
Maricopa County
My commission expires: My Commission Expires
/0 • 22 2- 0 /) October 28, 2018 (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 480000039
(if known) (6) Ar. 1 0 2018
Original Date of Issue 07/04/2017 A 12,
(if known) (7) ,---14.
Reason for original issue of Warrant/Check (8): ( . MARICOPA BOARD C LJNI
ill Payroll
LI For Services or Goods furnished
1=1 Other: Work Comp on FY17 PR26
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

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.
Ryan Cole for The Alliance (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about July 11,2017 (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 issue,41 to( /her in the sum of $ 8 .37 .(3)
Signed: iv7) (4)
4
(5) Subs ibed and sworn to before me this day of ing-if 20 /f-?
f '
11=1Nam.
11111)IIRY IIHUBL C MARIJON Notary Public ANDERSON -Arizona
Marlcope County
My commission expires: My October Commission 28, 2018 Expkes
/0 28.2619 (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 480002666
(if known) (6)
Original Date of Issue 07/11/2017 APNI 0- 2018
(if known) (7) __.____
.-jr4IPPN10/44,i0041el"
Reason for original issue of Warrant/Check (8): BOARD OF SUPERVISORS
El Payroll
Li For Services or Goods furnished
Li Other: Work Comp on FY17 PR26.1
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

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.
Ryan Cole for The Alliance (1), being first sworn, upon oath deposes and says:
Nanne/CTiimant
On or about July 18, 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 ihlm/her in the sum of $ 924.04 .(3)
Signed: _ (4)
(5) Subscribed and swornto before me this day of inA,,,e,4 20 /h) .
6 OtbutZ
NOTARY PUBL MARIJON ANDERSON
Notary Public - Arizona
My commission expires: My Maricopa Commission County Expires
/0 • Zg • 2ij ,q-2 October 28, 2018 P (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 480004992 DATEA ANN 0 2018
(if known) (6)
Original Date of Issue 07/18/2017
(if known) (7)
MARICOPA COUNTY
Reason for original issue of Warrant/Check (8):
• Payroll
O For Services or Goods furnished
O Other: Work Comp on FY17 PR27
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

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.
Ryan Cole for The Alliance (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about July 18, 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 hOher in the sum of $ 904.82 .(3)
Signed: (4)
—
(5) Subs ribed and sworn /to before me this P --• day of MA-e-ei-l- 20 /8 .
a
frIKC11IIYPUB12 ermarmorforriarassrrissrarrwarsare
MARIJON ANDERSON
Notary Public -Arizona
My commission expires: maricopa County
.213 • 208 My October Commission 28, 2018 Expires (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 480005003
(if known) (6) DA I A 1 0 2018
Original Date of Issue 07/18/2017
(if known) (7) ,04AA,A
K. BOARD OF SUPERVISORS
Reason for original issue of Warrant/Check (8): MARICOPA COUNTY
El Payroll
EJ For Services or Goods furnished
ii Other: Work Comp on FY18 PRO1
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

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.
Ryan Cole for The Alliance (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about August 1, 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 Vit/her in the sum of $2,087.44 .(3)
Signed: (4)
(5) Subscribed and sworn to before me this day of 20 /8 .
/IL AIA ,44
NOTARY PUBLIC
MARIJON ANDERSON
My commission expires: Notary Maricopa Public County -Arizona
10 L/ /0/ My Commission Expires (seal)
October 28, 2018
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 480009898 AP • 0 2018
(if known) (6)
Original Date of Issue 08/01/2017 ,.
(if known) (7)
CLERK, BOARD OF SUPERViSORS
MARICOPA COUNTY
Reason for original issue of Warrant/Check (8):
IN Payroll
111 For Services or Goods furnished
El Other: Work Comp on FY18 PRO2
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claindoc
Revised June 2015 A.R.S. 11-632 & 15-999

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.
Ryan Cole for The Alliance (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about August 15, 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 4 shown is due and owing, and the applicant requests that a replacement
warrant/che k be issued to Val/her in the sum of $ 4,528.05 .(3)
Signed: r (4)
(5) Subscr* ed and sworn to before me this 8-1--L? day of /141-11201-- 20 /8 .
NOTARY11...BLI MARIJON ANDERSON
Notary Public - Arizona
My commission expires: My Maricopa Commission County Expins
10 2g • 2,0 I g October 28.2018 (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 480014162 A 10 2018
(if known) (6) -)— '
Original Date of Issue 08/15/2017
(if known) (7)
CLERK.
Reason for original issue of Warrant/Check (8):
El Payroll
0 For Services or Goods furnished
0 Other: Work Comp on FY18 PRO3
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

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.
Ryan Cole for The Alliance (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about August 29, 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/checX be issued_ to Fj.f7her in the sum of $ 4,603.77 .(3)
Signed: (4)
(5) Subsgibed and sworn to before me this SL1 day of mitie..0,4 20 /2 .
MARIJON ANDERSON
Notary Public -Arizona
My commission expires: Maricopa County
10 ZY 2.619 My Commission Expires (seal)
October 28, 2018
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 480018603 AP 10 MIU
_cif known) (6)
Original Date of Issue 08/29/2017 .
(if known) (7)
Reason for original issue of Warrant/Check (8):
II Payroll
El For Services or Goods furnished
111 Other: Work Comp on FY18 PRO4
SAPROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc
Revised June 2015 A.R.S. 11-632 & 15-999

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.
Ryan Cole for The Alliance (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about September 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 1Am/her in the sum of $ 4,672.02 .(3)
Signed: (4)
(5) SubscO6ed and sworn to before me this g day of 1/)7 A-EU/ 20 /8 .
i/701t4(,Cr-,
NOTARY PUBLIC iip.IIIII••III•III•II•III•••IIII•III•••II••
MAR JON ANDERSON
Notary Public -Arizona
My commission expires: Maricopa County
/0 2g , 26/6) My October Commission 28, 2018 Expirts (seal)
11...10.111 7.1•11••I•I•••••••••••.11.11.111
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 480023451
(if known) (6)
Original Date of Issue 09/12/2017
(if known) (7)
Reason for original issue of Warrant/Check (8):
lil Payroll
For Services or Goods furnished
CI Other: Work Comp on FY18 PRO5
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

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.
Ryan Cole for The Alliance (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about September 26, 2017 / Oate)(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 h)/her in the sum of $ 4,657 .59 .( 3)
Signed: (4)
(5) Subscr)bed and sworn to before me this day of nee"! 20/8 .
NOTARY1eUBLI ANDERSON
._ ...., .... MARIJON Notary Public -Arizona
My commission expires: 0 41, My Maricopa Commission County Expires
7t ZE fa /8 -.-.., 441110\ October 28, 2018 (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 480027865 A" 10 1016
(if known) (6)
Original Date of Issue 09/26/2017 .• / ,
(if known) (7)
Reason for original issue of Warrant/Check (8):
Payroll
CI For Services or Goods furnished
111 Other: Work Comp on FY18 PRO6
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