Extracted text (via pymupdf_layout)
2741 characters
RECEIVED INTEROFFICE MEMORANDUM FEB,2 0 2018 ry Maricopa County Education Service Agency (aka CLERK BOARD CF SUPERVISORS Maricopa County Superintendent of Schools Office) Vt6 /6 TO: CLERK OF THE BOARD FROM: Terri Ysaguirre SUBJECT: Affidavits — Replacement of Lost Warrants DATE: 2/16/2018 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 Meza, Alejandro $50.00 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. -e 0,n d RD iine,Z Cu (1), being first sworn, upon oath deposes and says: NamelClaimant On or about ( a - 19 - a)()11 (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 issued to him/her in the sum of $ 50 .(3) Signed: (4) (5) Su cribed and s rn-co _before me this 15 day of RAymon 20 . / NOTARY PUBL os lb OFFICIAL SEAL BIANCA PERDOMO My commission expires: ,1 Notary Public- State of Arizona • a.4 • My MARICOPA Comm. Expires COUNTY Apiil 27, 2021 i (seal) ...I•••••=1• ••••••• 1.:••• I=i "WO. •I •• I •• MON • I •• II ••••MIS 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 ,9 00 q t 4-1 I -d, (c, 1 (Liaci ci (if known) (6) Original Date of Issue (if known) (7) --),01 -1 Reason for original issue of Warrant/Check (8): 1 APPR V E Ta- IX Payroll FED12 2 20 0 For Services or Goods furnished 0 Other: CLERK, Br, 'V7, 1., -;uPERVLSORS 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