Extracted text (via pymupdf_layout)
2693 characters
INTEROFFICE MEMORANDUM Maricopa County Education Service Agency (aka RECEIVE Maricopa County Superintendent of Schools Office) DEC 0 1 2017 MARICOPA COUNTY. CLERK BOARD OF SUPERVISORS TO: CLERK OF THE BOARD FROM: Terri Ysaguirre SUBJECT: Affidavits — Replacement of Lost Warrants DATE: 11/29/2017 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. #60 Higley Jessica Jeanne Johnson #180027228 $663.06 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. JOHNSON, JESSICA (1), being first sworn, upon oath deposes and says: Name/Claimant On or about ( OC I I 7 (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 is o him/her in the sum of $ 663.06 .(3) Signed: r (4) (5) Subscribed a worn to before me this day of No-1444 1v( 20 1 . ' 4 \ NOTARY PUBLIC OFFICIAL SEAL 1 LEAH CRUZ i My commission expires: Notary Public - State of Arizona i MAR ICOPA COUNTY I .26 - l„,...•_••_ ••_••_______••_ My Comm. Evires Oct, • 26, 2019 ! (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 180027228/ 60532401 (if known) (6) Original Date of Issue 11/09/17 - (if known) (7) -- I - Reason for original issue of Warrant/Check (8): DAT DEt, 04 2017 Payroll III For Services or Goods furnished K, KAAPIrr)PA BOARD OF r-r1 SUPERVISORS LI 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