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INTEROFFICE MEMORANDUM Waricopa County School' Superintendent's Office TO: CLERK OE DIE WARD RECEIVED FROM: Witiie Thompson FEB 2 3 2018 SUBJECT: Affidavits MARICOM - tf DATE: 2/22/2018 CLERK BOI o ','3`,JPERVISORS' Tase find attached 1 Affidavit/Notice of Craim(s)for Cost warrants for incrusion on the ne)ct avairaffe Board agenda (The attached item(s) have 6een researched to ensure that the warrant(s) in question have not 6een cashed or previously re-issued. The original-warrant(s) have had a stop payment done. If you have any questions, please contact Wilrie '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 X. CentrarAvenue #1200, ( 12 th Tibor) Thankyou. #216 AGO MIA AA-STA $840.00 q4- Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: g 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. AASPA (1), being first sworn, upon oath deposes and says: Name/Claimant On or about October 24, 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 uqd to,birn//rn the sum of $ Eight hundred forty and no/100 ,(3) Signed: (4) Nofe: Please atthch a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. (5) Subscribed and sworn to before me this day of /-;:e- 4Aj .-e." 20 IS , ka0.10L-si- NOTARY PUBLIC EilANk NOlary My commissioi expires: ilfly Commissioned CoMinission Epirus: for Jaci....son February Uoun41 25, 2010 i 7,2 57/e Commissioo Nun-O 14437339 (seal) Warrant/Check Number 480037804 (If known) (6) Original Date of Issue October 24, 2017 (if known) (7) Reason for original issue of Warrant/Check (8): El Payroll -- OF _ quPERVISOR • For Services or Goods furnished El Treasurer's refund/payment D Other: SAPROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc Revised April 2015 A.R.S. 11-632 & 11-644