020718 STALE DATED WARRANTS 1.PDF

INTEROFFICE MEMORANDUM
Maricopa County Education Service Agency (aka
Maricopa County Superintendent of Schools Office)
RECEIVED
DEC 19 2017
TO: CLERK OF THE BOARD MAFIICOPA COUNTY
CLERK BOARD OF SUPERVISORS
FROM: Terri Ysaguirre ‘(-0I
SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 12/18/2017
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.
#214 Tolleson Union NCA Resort/Hotel Camps #470038721 $1,200.00

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.
United Spirit Association (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about November 3, 2016 (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 .(3)
Signed: (4)
(5) Subscribed and sworn to before me this day of \\ 0\l'kA-N 1--)es- 20 t .
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NOTARY PUBLIC
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Note: Please attach a copy of the warranVcheck if available and/or any other
evidence that a warrant/check was originally issued.
Warrant/Check Number 214733783
(if known) (6)
Original Date of Issue 11/3/16
(if known) (7)
Reason for original issue of Warrant/Check (8):
O Payroll
II For Services or Goods furnished Registration Fees - USA Nationals/ Long B is
O 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

usa
unitedspiritassociation
A VARSITY SPIRIT BRAND
September 24, 2017
Mr. Jonathan Escobedo
Accounts Payable Clerk
Tolleson Union High School District #214
9801 West Van Buren Street
Tolleson, AZ 85353
Dear Mr. Escobedo:
This letter confirms that Kimberly Betts is authorized to sign the enclosed affidavit on behalf of the
United Spirit Association.
Thank you,
Michael 3,6 ,rg-c
President
5770 Warland Drive • Suite B • Cypress, CA 90630 • 800.886.4USA (4872) • 866.761.9365 fax • http://usa.varsity.com