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INTEROFFICE MEMORANDUM Waricopa County Schoo(Superinteneent's Office ECEIVED TO: CLERK OT TOE (BO)4RD APR 0 4 2018 FROM: Wale ¶Thompson MARICOPA COUNTY SUBJECT: Affidavits CLERK BOARD OF SUPERVISORS DATE: 4/3/2018 Pase find attached 1 AffidavitOotice of Craim(s)for Cost warrants for incrusion on the next avaiCa6Th Ooard agenda The attached item(s) have been researched to ensure that the warrant(s) in question have not been cashed or previous Cy re-issued The original-warrant(s) have had a stop payment done. If you have any questions, pfease contact Willie Thompson at 372-1244 or via e-mair at mthompson@mcesa.maricopagov. Approved Affidavits may be routed 6ack to the Superintendent of School- Einance Division at 4041 X. Central-Avenue #1200, ( 12 th Eroor) Thankyou. # 201 OVCICETE V7V70.70f5 7Cervin7CEITis $520.86 Schoolis Affidawiltinakin Form AppHcailon for a Dmcate VdarrantiCheth (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. Kelvin K. Ellis (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 422 /18 (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 $ 520.86 .(3) Signed: (4) (5) Subscribed and sworn to before me this 02.ind day of 11 20 . 2%,(A 1 -/Liti-v/717 ARY PUBLIC LESLIE STIRMAN Notary Public - Arizona My commission expires: Maricopa County My Comm. Expires Dec 27, 2021 (seal) Nrite: 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 201624646 /180050535 (if known) (6) Original Date of Issue (if known) (7) Reason for original issue of Warrant/Check (8): al Payroll El For Services or Goods furnished ERK, MARICOPA BOARD OF COUr SUPERVISORS LI Other: 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