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INTEROFFICE MEMORANDUM Ilaricopa County School" Superintendent's Office RECEIVED TO: CLERK OE 'PPE 00ARD FROM: Wale Thompson FEB 2 7 2018 SUBJECT: Affidavits MARICOPA COUNTY CLERK BOARD OF SUPERVISORS DATE: 2/23/2018 PThase find attached 1 Affidavit/Xotice of Craim(s)for Cost warrants for incfusion on the ne.v avaita6 Ooard agenda -\1 The attached item(s) have been researched to ensure that the warrant(s) in question have not 6een cashed or previous()) re-issued The original-warrant(s) have had a stop payment done. If you have any questions, c&I,se contact Willie Thompson at 372-1244 or via e-mad at mthompson@mcesa.maricopa.gov . Approved Affidavits may be routed 6ack to the Superintendent of Schoor finance Division at 4041 X. Central -Avenue #1200, ( 12 th Efoor) Thankyou. #68 ALY15110M EACILITYWAXAGE9VIE1VT GROVP $17,206.88 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. Facility Management Group (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 02/06/2018 (d ate) (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 tohim/her in the sum of $ 17206.88 •(3) „ 11 - Signed: (4) (5) Subscribed and sworn to before me this ‘Z -2- day of 20 /6 . NOTARY PUBLIC SUZANNE C. KM Nday Mite cfkkons My commission expires: My MARICAPACOUNTY CO1=1881011 Exptres 02/00/2018 .„14 July 26, 2020 eal) 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 480069632 , FEB 8 201 ( (If known) (6) Original Date of Issue 02/06/2018 .. • ..,. (If known) (7) _F_RK, BOARD OF SUPERViSORS Reason for original issue of Warrant/Check (8): MARICOPA COUNTY L] Payroll LI For Services or Goods furnished INVOICE 1320 Other: INVOICE 1320 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