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INTEROFFICE MEMORANDUM Ilaricopa County School.Superintendent's Office TO: CLERK OE TOE 00ARD RECEIVED FROM: Willie 'Thompson SUBJECT: Affidavits MAR 0 1 2018 DATE: 2/28/2018 CLERK MARICOPA BOARD OF COUNTY' SUPERVISORS Pase find attached 2 Affidavit/Trotice of Craim(s)for Cost warrants for indusion on the next avada6Th Ooard agenda The attached item(s) have 6een researched to ensure that the warrant(s) in question have not been cashed or previously re-issued The original warrant (s) have had a stop payment done. If you have any questions, please contact Willie 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 N. Central. Avenue #1200, ( 12 th Floor) Thankyou. #,IfIGLET LISA PEARSON - $200.00 #401 EVIT 77IWA GALLEGOS $381.64 Schools Affidawk/Ciaim 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. Lisa Pearson (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 1 AINI1r7 (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,l)e issued to him/her in the sum of $ 200.00 .(3) Signed: ik-o-e-)ReAt9tA, (4) (5) Subscribed and sworn to before me this day of (,:);. L 20j. NOTARYPUBLIC OFFICIAL SEAL LEAH CRUZ My commission expires: Notary Public - State of Arizona I MARICOPA COUNTY 1 ‘...1 74\747 J My Comm. Expires Oct. 26, 2019 (seal) 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 480054007 Of known) (6) I A - Original Date of Issue 12/14/2017 I DA:A7F._ MA Oriy , _, (if known) (7) Reason for original issue of Warrant/Check (8): rRK, BOARD OF SUPERVISORS 0 Payroll MARICOPA COUNTY For Services or Goods furnished Proportionate Share CI Other: Proportionate Share Revised S: \PROCESSES June 2015 \Warrants - Duplicate or Stale \02 Forms\Schools\Schools-Warrants Checks notice of claim.doc A.R.S. 11-632 & 15-999 41-10( 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. (1), being first sworn, upon oath deposes and says: On or about TEL ZZ ) Zo 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/ch ck be issued to hirn/her. in the sum of $ '3 24 .L.9L4 .(3) Signed: (4) (5) Subscribed and sworn to before me this £'7 —day th of 20 / NOTARY PUBLIC OFFICIAL SEAL My commission expires: NOTARY BARBARA PUBLIC- SPIELBUSCH STATE OF ARIZONA (7)) rdi-e---A c.) Comm. MARICOPA Expires COUNlY March 1, 2018 ( 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 cct)(3 Lk) \ 2---7 _ __ (If known) (6) I A PPRO • , — Original Date of Issue 1" 0 1-7 I _. ...A 01 _ 0 7 2018 , (if known) (7) Reason for original issue of Warrant/Check (8): y -D Payroll CLERK, MARICOPA BOARD OF COUNTY SUPERVISORS 0 For Services or Goods furnished IA Other: S; \ PROCESSES\Warrants - Duplicate or Stale\02 Forms \Schools\Schools-Warrants Checks notice of claim.doc A.R.S. 11-632 St 15-999 Revised June 2015