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INTEROFFICE MEMORANDUM Maricopa County School-Superintendent's Office TO: CLERXOE TOE 00ARD RECEIVED FROM: MilTie Thompson JAN 3 1 2018 SUBJECT: Affidavits MARICOPA CUMIN DATE: 1/31/2018 CLERK BOARD OC- SUPETIVISORS t66:1 ..rqb Pase find attached 1 Affi6avit/g1rotice of Craim(s)for Cost -warrants for incrusion on the next avaira6Th Ooard agenda The attached item(s) have 6een researched to ensure that the warrant(s) in question have not 6een cashed or previousCy re-issued The original-warrant(s) have had a stop payment done. If you have any questions, pase contact Willie Thompson at 372-1244 or via e-mad at mthompson@mcesa.maricopa.gov . Approved Affidavits may he routed back to the Superintendent of School . Finance Division at 4041 1I1. Central- Avenue #1200, ( 12 th Efoor) Tfiankyou. #59 LAVEEN PROP-HET CORPOWATION . $1394.24 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. The Prophet Corporation (1), being first sworn, upon oath deposes and says: Name/Claimant or about December 12, 2017 O (date) ate)(2) (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 $ One thousand three hundred ninety-four and 24/100 (3) Signed: 61/1^^^ -e2?5"0.26 (4) Note: Please atta 4 a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. (5) Subscribed and sworn to before me this as4A- day of 20 • NOTARY PUBLIC MICHELE A. SKALA My commission expires: NOTARY PUBLIC - MINNESOTA 1 / 3 Vi My Commission Expires Jan. 31, 2020 (seal) Warrant/Check Number 480053053 (if known) (6) A-P-P-R-0-71-46 Original Date of Issue December 12, 2017 JA 1 An (If known) (7) Reason for original issue of Warrant/Check (8): CLERK, BOARD OF SUPERVISORS 0 Payroll MARICOPA COUNTY gi For Services or Goods furnished 0 Treasurer's refund/payment El Other: S: \ PROCESSES \Warrants - Duplicate or Stale \ 02 Forms \Warrants Checks notice of claim - Copy.doc A.R.S. 11-632 & 11-694 Revised April 2015