022118 DUPLICATE WARRANTS 2.PDF

E s
Maricopa County Fiducation Service Agency
Date: January 22, 2018
RECEIVED
To: Clerk of the Board
JAN 2 3 2018
From: Terri Ysaguirre MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS
Subject: Affidavits Ke6
Please find attached the attached (4) Affidavit/Notice of Claim(s) for lost warrants for inclusion
on the next available Board agenda.
The attached item(s) have been 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 Terri Ysaguirre at 602-372-1245 or via e-mail
at terri.ysaguirre@mcesa.maricopa.gov .
Approved Affidavits may be routed back to the Superintendent of School Finance Division at
4041 N. Central Ave, Ste 1200 (12t h Floor). Thank you.
*****************************************************************************
#44 Avondale Teaching Stuff $49.62
#44 Avondale Eulijio Guerrero $279.30
#66 Roosevelt Smita Jayant Vaidya $449.75
#59 Laveen Countrywide Promotions/
LLC dba Spiritwear.com $896.38
4041 N. Central Avenue, Ste. 1200, Phoenix AZ 8501 2 • Phone 602-372-4833 • Fax 602-372-8589
www.maricopa.gov/schools Known as experts. Renowned for service.

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
, OUNTY OF MARICOPA Instruction sheet which is page 2 of this form.
' ( C (-ii d (1), being first sworn, upon oath deposes and says:
Name/Clal4t
On or about U-D.,(,-,,P.,0{11 (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 be issued to him/her In the sum of $ 4 01 , Co<9. .(3)
(4)
em-- day of71/10/9a 20/Z
OFFICIAL SEAL
LASHOt4NE DRAKE
Notary Public - State of Arizona
MARICOPA COUNTY
My Comm. free Dec. 6: 2018. • (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 LK b 0 LA 1-1 /-1 V-1 / 44'1
(if known) (6)
Original Date of Issue 1
(if known) (7) -
Reason for original issue of Warrant/Check (8):
El Payroll
1E1/ For Services or Goods furnished 0a‘...,517-coiv) Q.A(Y\ E. K, BOARD OF SUPERVISORS
MARICOPA COUNTY
El Other:
SAPROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc
Revised June 2015 A.R.S. 11-632 & 15-999

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: El Duplicate or El Stale-Dated (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:
6,rne-i e cl(I's-rnra9e
On or about - PF - I (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 be issued to him/her in the sum of $ 9:79 , 5C) .(3)
Signed: (4)
Note: Plege attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
(5) Su iscribed and sworn to before me this Pi\ day of J Otfin.A1(LY\ 20 1( •
NOTA PUBLIC
OFFICIAL SEAL I
AURA NELSON j
My commission expires: Na?ry Public - State of Arizona
\C"C. 2-D1 9 MARICOPA COUNTNeil)
`Niii_f% my Comm. EvIres Dec. 28, 2019
Warrant/Check Number i'DO 4 1 DOD
(if known) (6)
Original Date of Issue
(if known) (7) 0--*Xcg - JAM 3 2018
Reason for original issue of Warrant/Check (8):
El, Payroll CLERK, MARICOPA EOrkr-iD COUNTY
0 For Services or Goods furnished
0 Treasurer's refund/payment
0 Other:
SAPROCESSES\Warrants - Duplicate or Stale\02 FormsMarrants Checks notice of claim - Copy.doc
Revised April 2015 A.R.S. 11-632 & 11-644

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.
VAIDYA, SMITA JAYANT (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about Pe, PrYii),cr d_Cii4-(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 be issued to him/her in the sum of $ 449 . 75 .(3)
Signed: (4)
(5) Subscribed and sworn to before me this I (0 W day of lJavwo P-L/ 20 I g
Q44/L4} M71 cv
NOTAR PUBLIC
My commission expires:
I./(o (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 180038313/66895354
(if known) (6)
Original Date of Issue 12/08/2017
(if known) (7)
Reason for original issue of Warrant/Check (8):
IV Payroll
CLERK, BOARD OF SUPERVISORS
CI For Services or Goods furnished MARICOPA COUNTY
111 Other:
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

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: • Duplicate or 0 Stale-Dated (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.
Countrywide Promotions, LLC/Spiritwear.com (i) being first sworn, upon oath deposes and says:
Name/Claimant
On or about August 10, 2017 (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 be issued to him/her in the sum of $ Eight hundred ninety-six and 38/100 (3)
Signed: Citkvkcr7,1/21) (4)
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued,
(5) Subsyed and sworn to ‘ by f re me this \O day of --5-AIAC(O-A/3- 20 .
W
NOTARY PUBLIC
.4C) NOTARY rQ'
PUBLIC
My commission expires: GEORGIA
g • EXPIRES (seal)
AuGUST 25,2018
Warrant/Check Number 480013636 \0
(if known) (6)
Original Date of Issue August 10, 2017
(if known) (7)
A to s4
Reason for original issue of Warrant/Check (8): JAN 2 3 2018
0 Payroll DAT;
IA For Services or Goods furnished
MARICOPA L/ COUNTY
0 Treasurer's refund/payment
0 Other:
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc
Revised April 2015 A.R.S. 11-632 & 11-644