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INTEROFFICE MEMORANDUM Maricopa County Education Service Agency (aka Maricopa County Superintendent of Schools Office) RECEIVED TO: CLERK OF THE BOARD FEB 1 3 2018 FROM: Terri Ysaguirre MARICOPA COUNTY. CLERK BOARC OLiPERVISORS SUBJECT: Affidavits — Replacement of Lost Warrants t<t6 DATE: 2/13/2018 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. #81 Nadaburg Elementary James P Scott $187.67 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. Cranle- f (1), being first sworn, upon oath deposes and says: Name/Claimant On or about g .10-2(.91. 7 (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 0-7 warrant/check be issued to him/her in the sum of $ .(3) Signed: (4) (5) Subscribed and sworn to before me this day of 20 NOTARY PUBLIC My commission expires: (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 (if known) (6) 141 00 g cit4O-C Original Date of Issue A Ito IP git e / (if known) (7) 7 FD A 1 5 2018 Reason for original issue of Warrant/Check (8): El Payroll CLERK, BOARD OF SUPERVISORS MARICOPA COUNTY 0 For Services or Goods furnished D Other: SAPROCESSESNWarrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim,doc Revised June 2015 A.R.S. 11-632 tk 15-999 LOST CHECK AFFIDAVIT NADABURG UNIFIED SCHOOL DISTRICT NO.81 I, James Scott, being first duly sworn, do depose and say that I, James Scott, am the entity named as the payee of the warrant number 470084405, drawn by the Treasurer of Maricopa County on March 30, 2017 for the sum of $187.67. Being still sworn, I further say that the above described check has not been received or negotiated by me. The above described check has been lost, and, by this affidavit, I am requesting that the Nadaburg USD, County of Maricopa County place a stop payment on the above-described check and issue a replacement check. I understand that under no circumstances should I present the above-described check for payment if it should come into my possession after the filing of this affidavit, and I hereby indemnify and hold harmless the Nadaburg School District form any liability, loss, expense, or damage which may occur as a result of the issuance of the original check and/or the replacement check. 0 Affiant's Signature Sworn to and subscribed before me this --4L 1 day of AkON\A , 20 \ . Notary Public in and for My Commission akpires \I\ kiSDAAST %.1dIwieriak.dfb..11..lek c:)0 C CHRISTINA MURRA.V Notary Public - Arizona Maricopa County 6V- My Comm. Expires May 11,2018 For questions, contact: Nadaburg Unified School District No.81 Teresa Minkner Business Services (623) 388-2133 32919 N Center Street tminkner@nadaburgsd.org Wittmann, AZ 85361