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INTEROFFICE MEMORANDUM Maricopa County Education Service Agency (aka Maricopa County Superintendent of Schools Office) RECEIVED MAR r 5 2018 TO: CLERK OF THE BOARD MARICOFA COUNTY FROM: Terri Ysaguirre CLERK BOARD OF ;1VJPERVISORS SUBJECT: Affidavits — Replacement of Lost Warrants DATE: 3/13/2018 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. #216 Agua Fria Union Excellence Industries $640.00 #216 Agua Fria Union RWC International $843.14 #8 Osborn Elementary Johnstone Supply $141.58 #94 Paloma Elementary Chatter Therapy Services $3,000.00 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. EXCELLENCE INDUSTRIES (1.), being first sworn, upon oath deposes and says: Name/Claimant On or about 09/05/17 (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 hinn/her l in the sum of $ 640.00 .(3) Signed: ka (4) (5) Subscribed/anchsyvorn before me this day of 14 20 Li; . NOTARY/PUBLIC My commission expires: ELLEN Commission D ALEXANDER # FF 969682 My Commission Expires (seal) March 09, 2020 Note: Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. WaifailliCheck Number 216710818/480022338 (if known) (6) Original Date of Issue 09-05-2017 (if known) (7) Reason for original issue of Warrant/Check (8): 111 Payroll CLERK, BOAID OF For Services or Goods furnished MARICOPA COUNTY El 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 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. R W C INTERNATIONAL (1), being first sworn, upon oath deposes and says: Name/CTaimanl On or about I /4 e (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 $ 843.14 .(3) Signed: 4.1/azik_ (4) (5) Subscribed and sworn to before me this '0\ --1 day of U 20 NOTARY PUBLIC MARILYN GOMEZ My commission expires: NOTARY PUBLIC, ARIZONA Oi 1 9-1 I 9- 02 My MARICOPA Commission COUNTY Expires (seal) January 21, 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 480060867/21674667 (if known) (6) Original Date of Issue 1/11/2018 (if known) (7) MIAR 9 n 2111A Reason for original issue of Warrant/Check (8): Payroll '.._,DL I=7-1/i5OnS MARICOPA COUNTY II For Services or Goods furnished PARTS II Other: PARTS 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 *•' Is" . 5 School Is Affidavit/Claim Form ApplIkteltio.irii fair a. Pulilicat6 Warrailtt/check • (definitidns are on age 2 STATEbr ARIZONA,. • • Note: Nurrib.ers.on thIS forfitoorresponti to niimb.ere on the . ••;•COUNTY 0141ARIOOPA • • ArietructiOn sheet whlohds page 2 of this form. . „era tr11,175.111 • ' . CO 0 eing irst sworni: upon. oath -deppses and says: 01, alma!! • On :or about IQZ 11,-Dr/ .(date)(.) a Warrant/check was isSued to the .abOve named. person/entity in:the amount as tatedbeloW Such warrant/check was either never received or was subsequently:Inadvertently lost Or destroyed and there is n6 reasobP 'Probability or. its. being 'fo'und. or presented 'for Pay.rrient, 0 it was not • presented for payment within one year after the date of issuance. Therefore/ under..penalty of perjuey, .cialmant hereby affirmsthat this claim Is correct 6nd.the'arriount shown is due and owing, and the applicant requests that a replacement Warrant/check be Issued tb him/her In the sum of $ ,!:)2 •(3) 1. _.(4) .:15);Sylisribed'and'swOrn 'to before thethi: day of. 54 • . I"' A NOTARY . • • , PthEil •.- •• • • , , . cONNIE KOVAL • . . • • • . . . NOTAIA1FPUBLId . STATE OF NVAE)A.,. . $.....• • t'r."1Me:/,,i; . . My,C,OismissioqiitilreS!0946.21' ' (seal) . COMM° No; 17;3B03.1 f.! •copy Or Stig',Y.v4100/4 -17eck .avallable.iarld/prfany .other dy/AY•7.0417;It'q'warratit -/chOck was oildinally . Issued.,- . • •••. • . . • Mrrant/CheCk Minter. LI ,,,, ,,,__... ,,.., . . , . . .. . -;.,.....,::.... (if kneVini. . •., . 0(..") . 9-LY'3'1.._ . • — .' • . : .:-.-. ' .: • •. ..." .'. Origina,1 '' •:•:% • -((f.known) Date of:ISSuq,; .• ..1 I 1 .0;j.. - .0. [ . . .. ,,., .,, ..,..: .-.:: !.: .:i . (7) - ' - Masbri"for',011-gf61 issue. of Warrant/Check • • • . • . , evices,Or..Goods furnished.... . CLERk, BOARD OF LJPEFV1'50)Plt': .MARICOPA COUNTy . . !J• ••• st• ;;. •• • " • *. ,••.• • • • • " • • q . • ••• • • •• • . • 1,s • ' . .,,' :r••••• .. ' • • •I *, 'i ,• ..; ...•.' • • • • • • , . . ..• ..., . . . - • . . :. • . .1 ,:..s .,\PKOC:E.se.3Eskyvairiiii •.:.' • ; k Duplicate:or Stalek02 Forms\ Sahodls\Sefi6OlsVarrant's *Chee6•tiotIce of clald.ctoc ' ..: ,. Revlsod June 2015 . . .. ••• • . • . • . • ... . " , • A.KS. 11-63i 805-999 . ••• i • ' ',- ,...r: 't1 7;' ,F.•/:-...".: —;" • ". ' . • : . .f'..,„.0 .....:„ .. 41, •.•:••:•••,!... . ,, , '1••••..... . • ' ••••• „ • •• . ' * •• • * •••• •• .•••:.: ,v Schools Affidavit/Claim Form Application for a Duplicate Warrant/Check (definitions are on page 2) S E OF ARIZONA Fm ARc p A Note: Numbers on this form correspond to numbers on the COUNTY Instruction sheet which is page 2 of this form. ei Ca tcr 1910 apt ( .er vic RVYLe r : I<CL-h I (1), being first sworn, upon oath deposes and says: Name/claimant 1 On or about Li I 0 dt) 1 I (date)(2) a warrant/check was issued to the above named persoh/entily 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 $ C .(3) Signed: —3 (4) (5) subscribed and sworn to before me this 8th day of March 20 18 . flft L4 \iatActo NOTARY PUBLIC My commission expires' Irma Web Garcia Notary Public (seal) Maricopa County, Arizona 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 1-1-1 00 sR c<0(-1 (if known) (6) Original Date of Issue LF I 0 s 9.01 —1 20 2 (if known) (7) i r,A4 - . ii Reason for original issue of Warrant/Check (8): CLERK. BOARD Cr SuPERV,60RS . 0 Payroll MARICOPA COUNTY For Services or Goods furnished Speech Services El Other: Speech Services 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