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INTEROFFICE MEMORANDUM Maricopa County Education Service Agency (aka Maricopa County Superintendent of Schools Office) RECEIVED JAN 3 1 2018 TO: CLERK OF THE BOARD FROM: Terri Ysaguirre MARICOPA CLERK BOARD UPERVISORS SUBJECT: Affidavits — Replacement of Lost Warrants DATE: 1/29/2018 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.ysaguirre@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. #68 Alhambra AASPA $3,200.00 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. AASPA (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 12/01/2017 (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/bpr in the sum of $ 3200.00 43) Signed: (4) (5) Subscribed and sworn to before me this day of 20 a • kat.6W-u4. (.7 e7v)tta NOTARY PUBLIC DIANE T. CONNELLY Notary Public My commission expires: Commissioned for Jackson County -12/04/2017 My Commission Commission Expires: Number February 19437339 25,2018 (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 Ai et — le is'A %60 7 ail, 4.-., (if known) (6) 480048914 JA 1 2(11 DA • ." Original Date of Issue 12/01/201 7 .. (if known) (7) CLERK. BOARD OF SUPERVISORS Reason for original issue of Warrant/Check (8): MARICOPA COUNTY LI Payroll El For Services or Goods furnished REGISTRATION FOR AASPA CONFERENCE RI Other: REGISTRATION FOR AASPA CONFERENCE 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