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RECEIVED rE=e=m2=04,8. INTEROFFICE MEMORANDUM MARICOPA COUNTY GLERK,B0A,RoraURERVISORS Maricopa County Education Service Agency (aka 0 1-1 1 Maricopa County Superintendent of Schools Office) TO: CLERK OF THE BOARD FROM: Terri Ysaguirre SUBJECT: Affidavits — Replacement of Lost Warrants DATE: 1/31/2018 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. #45 Fowler Elementary Easley's Fun Shop $687.03 Schools Affidavilt/Uarni Form Application for a Duplicate Warrant/Check (definitions are an pane 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. ear F.451.-01/5 i (1), being first sworn, upon oath deposes and says: me/U la inlan On or about (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 warra be issued tr, im/her In_the sum of $ 07.03 .(3) Sign (4) P • • 5) Subscribed and sworn to be Or e me this )941.1 day ofai uctii 20 1g NOTARY PUBLIC DEBBIE A QUINONES NOTARY PUBLIC, ARIZONA My commission expires: MARICOPA COUNTY My Commission Expires (seal) April 05, 2021 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 41700g41/92_ (If known) (6) Original Date of Issue (if known) (7) Reason for original issue of Warrant/Check (8): Li Payroll 71, For Services or Goods furnished TLERK. BOARD dB OF S.: -'7 7, V:SORS Li Other: SAPROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools16chools•Warrants Checks notice of cialm.doc. Revised June 2015 A‘R.5, 11-632 & 15-999