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RECEIVED 7-irt-0=7 INTEROFFICE MEMORANDUM MARICOPA COUN1Y Maricopa County Education Service Agency (aka CLERK HOARD OF SUPERVISORS Maricopa County Superintendent of Schools Office) TO: CLERK OF THE BOARD FROM: Terri Ysaguirre SUBJECT: Affidavits — Replacement of Lost Warrants DATE: 12/1/2017 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. #44 AVONDALE Jill Pitts #180028365 $1,519.23 #214 TOLLESON UNION RedTree Consulting Group #480033180 $4,750.00 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form • This application is for: Duplicate or 1-11 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. Jill Pitts (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 11/16/17 (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 i ued to hirn/her in the sum of $1, 519.23 .(3) Signed: (4) Note: Plase attach 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 \ day of Nwerof ; 201/ . RAQUEL ARAUJO Notary Public- Slate of Arizona My commission expires: My MAR Commission ICOPA COUNTY Epires,, 0\4 10 1'2_0 April 30, 201g,seal) Warrant/Check Number 180028365 (if known) (6) 441?PillOVED Original Date of Issue (if known) (7) Reason for original issue of Warrant/Check (8): LL ERK, BOARD OF SUPERVISORS Payroll MAR1COPA COUNTY O For Services or Goods furnished El Treasurer's refund/payment O Other: S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc Revised April 2015 A.R.S. 11-632 81,11-644 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. RedTree Consulting Group (1), being first sworn, upon oath deposes and says: Name/Claimant On or about October 10, 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 owipjvand the applicant requests that a replacement warrant/check be iss.ued t im IF sum of $ 4,750.00 .(3) Signed: (4) (5) Subscribed and sworn to before me this gOikday of AkVernke 20 ; . My commission expires: Milrch d (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 480033180/214742775 if known 6 1 0 J r. Original Date of Issue 'IaitialliirliMI if known 7 10/10/17 AK. BOARD OF SUPERVISORS Reason for original issue of Warrant/Check (8): MARICOPA COUNTY 111 Payroll • For Services or Goods furnished Consulting Fees for Roof at Copper Canyofi El 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