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INTEROFFICE MEMORANDUM Maricopa County Education Service Agency (aka Maricopa County Superintendent of Schools Office) RECEIVE JAN 2 5 2018 TO: CLERK OF THE BOARD MARICOPA COUNTY. FROM: Terri Ysaguirre CLERK BOARD OF SUPERVISORS SUBJECT: Affidavits — Replacement of Lost Warrants DATE: 1/25/2018 Please find attached 1 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. 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. #65 Littleton Elem Waxie Sanitary Supply $1,139.95 Stop Payment As la ="4scaos. Affidavit Business Resources x.sI.I STATE OF ARLIWITA° COUNTY OF MARKOP—A- Waxie Sanitary Supply , being first duly sworn, upon oath deposes and states: That on the 6 day of November , 20 17 , he/she presented to Littleton Elementary School District No. 65, of Maricopa County, for payment, a claim for services rendered or supplies furnished during the month of November , said claim being in the sum of One thousand one hundred thirty nine .95 Dollars ($ 1,139.95 ) in payment of which Littleton Elementary School District No. 65 caused warrant/check number 480043426 to be issued on 9 day of November , 20 17 drawn on the warrant/check fund of Littleton Elementary School District No. 65 of Maricopa County, Arizona. Affiant further states that although he/she was informed and believes that the above mentioned warrant/check was regularly issued, the same has never been received, or has been lost. Wherefore, affiant requests that the Governing Board order and the Littleton Elementary School District No. 65 issue to him/her a replacement of said warrant/check number480043423 in the sum of $ 1,139.95 Signature / 04k Subscribed and sworn before me this r..."77 A1, 7—grar‘ri‘ATo-rn z Signature of Notary Public comm. #2121297 co NOTARY PUBLIC • CALIFORNIA gs SAN DIEGO COUNTY 1...w.wafimmywommoommwdwww6 Commission Expires Aug. 25, 2019 J My Co mission Expires CLERK, BOARD OF SUPERVISORS MARICOPA COUNTY 03/2013 CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE § 8202 svt.ATO,P,141/CAVC-0:1s\C"AR.21,4 sst /<( See Attached Document (Notary to cross out lines 1-6 below) CI See Statement Below (Lines 1-6 to be completed only by document signer[s], not Notary) Signature of Document Signer No. 1 Signature of Document Signer No. 2 (if any) A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of Calif r ia Subscribed and sworn to (or affirmed) before me County of a,- 0 ler 's on this ialt\ day of by Date Year CANA-1- ..J1 (1) (and (2) NW Name(s) of Signer(s) SANDRA E. VAZQUEZ comm. #2121297 ca NOTARY PUBLIC • CALIFORNIA g proved to me on the asis of satisfactory evidence SAN DIEGO COUNTY 25, 2019 t to be the perso(sy who appearp..0 before me. Commission Expires Aug. Signature Seal Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: p Document Date: h (7 Number of Pages: Signer(s) Other Than Named Above: ©2014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5910 fgXet iRfU 07--.1414.1:1V0PA IOENIX, ARIZONA • TR . IS WARRANT DRAWS INTERE$T•FROM DATE MARKED 'INOUFFICIENT FUNDS' 8NITEFIEST STOPS ON DATE FtINPS AVAILABLE. (SEC ARM 936) 11/09/2017 65774015 LITTLETON ELEMENTARY SCHOOL DISTRICT #65 PAY *"One Thousand One Hundred Thkty Nine and 95i100*** Dollars $1,139.95 VOID AFTER 365 DAYS TO WA)UE .SANITARY SUPPLY THE ORDER OF upetin .errg 110" c onk .AUTHORIZED SIGNATURES 04800113423o 1: in 1110912017 Check: 65774015 EXPENSE MARICOPA COUNTY SCHOOLS • PHOENIX, ARIZONA AP 11113117 480043423 WAXIE SANITARY SUPPLY 11/09/2017 Payee I Check Date VOUCHER: 1058 TOTAL: $1,139.95 HARLAND CLARKE M22692 70132180