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INTEROFFICE MEMORANDUM Maricopa County Education Service Agency (aka Maricopa County Superintendent of Schools Office) RECEIVED DEC 0 8 2017 MAR1COPA COUNTY TO: CLERK OF THE BOARD CLERK BOARD OF SUPETIV1 S FROM: Terri Ysaguirre SUBJECT: Affidavits — Replacement of Lost Warrants DATE: 12/7/2017 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 terriNsaguirre@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. #17 Tolleson Elem Compass Group USA Inc #480043903 $163,062.46 #25 Liberty Mary Anne Budden #180020367 $124.25 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. OornpoaSs Group USIA Inc (1), being first sworn, upon oath deposes and says: Name/Claimant On or about Kw/ember (date)( \(2) 2) a warrant/check was issued to the 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 $ 103, 002,, LIAO .(3) Signed: (4) (5) Subscribed and sworn to before me this day of 21ecember 20 /7. NOTARY PUBLIC ISABEL DEL TORO My commission expires: Notary Public - Arizona F-1910' J 3,04 ‘C) My Comm. Marlcopa Expires County Feb 27, 2020 (seal) "M.. 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 (if known) (6) LoC Original Date of Issue A-LPIA13.1113-B (if known) (7) /1.14,2-01q- Reason for original issue of Warrant/Check (8): CLERK, BOARD OF SUPERVISORS El Payroll MARICOPA COUNTY X For Services or Goods furnished 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 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. dzartfAinne gucide4 (1), being first sworn, upon oath deposes and says: amelCiaimant On or about /0 -/2-/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 issued to him/her in the sum of $ /a? V- Z5— .(3) Signed: (4) (5) Subscribed and sw rn to before me this z311k day of rD_P_Le ill/A_ 2011 . I • 4, k .ALIA 46.I Karipa-Matstama NOTARY PUBLIC Notary Public - Arizona MARICOPA COUNTY My Commission Expires My commission expires: December?; 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 , . 7 (if known) (6) /geo..036 Original Date of Issue -/7 APPR.CIVED (if known) (7) Reason for original issue of Warrant/Check (8): IA Payroll CLERK, BOARD OF SUPERVISORS For Services or Goods furnished MARICOPA COUNTY II 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