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INTEROFFICE MEMORANDUM Waricopa County Scnoof Superintendent's Office RECEIVED TO: CLERK OE ME BOARD FEB 1 6 2018 FROM: Willie (Thompson MARICOPA COUNTY SUBJECT: Affidavits CLERK BOARD OF SUPERVISORS DATE: 2/15/2018 Pase find attached 1 Affidavit/Notice of Cfaim(s)for fost 'warrants for incfusion on the noct avai1a6 Board agenda The attached item(s) have 6een researched to ensure that the warrant(s) in question have not 6een cashed or previous& re-issued The originaf warrant(s) have had a stop payment done. lf you have any questions, pfease contact llitrie 'Thompson at 372-1244 or via e-mail - at mthompson@mcesa.maricopa.gov . Approved Affidavits ma y be routed back to the Superintendent of Schoof Einance Division at 4041 1I1: Central-Avenue #1200, ( 12 th Efoor) Thankyou. #7 wIrsow - cirwricIA CAWIPTON $ 112. 50 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. Cynthia Campton (1), being first sworn, upon oath deposes and says: Name/Claimant On or about ///2 W/ (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 owin g, and the applicant requests that a replacement warrant/check_be issued to him/her in the sum of $112.50 .(3) Signed: (4) (5) Suhsciplbed and swo before me this /.3117 day of Oil" 201&_. 71/1///// I WiAaqiiii/A ALICIA GUZMAN Notary Public-Arizona My cgt1f757ires: My Comm, Maticopa Expires County Dec 19,2021 aoIII•••III•I••I•I•I••wmirmwolt (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 470090473 APPR0V El (if known) (b) FEB.' 6 2018 Original Date of Issue 04/20/2017 (if known) (7) Reason for original issue of Warrant/Check (8): RK MARICOPA BOARD OF COUNTY SUPERVISC . El Payroll El For Services or Goods furnished Reimbursement for earbuds purchased that were used for AzNIERIT testing. Other: Reimbursement for earbuds purchased that were used for AzMERIT testing. S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of clairn.doc Revised June 2015 A.R.S. 11-632 & 15-999