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INTEROFFICE MEMORANDUM _ 911aricopa County School-Superintendent's 0 RECEIVED TO: CLEWK TYPE BOARD FROM: /liffie Thompson NOV I 5 2017 SUBJECT: Affidavits MARICOPA COUNTY CLERK BOARD OF SUPERVISORS DATE: 11/14/2017 V_6) I/O Pase find attached 1 AffidavitOotice of Claim(s)for Cost warrants for inclusion on the noct 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 -\1 The original warrant (s) have had a stop payment done. If you have any questions, please contact Wile Thompson at 372-1244 or via e-mail at mthompson@mcesa.maricopa.gov . Approved Affidavits may be routed back to the Superintendent of School Finance Division at 4041 X. Central. Avenue #1200, ( 12 th 'Floor) ghankyou. #44 AVONDALE 914EREDTDCBISOOM $477.45 i_sx( 2..-w17"5 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form • This application is for: Duplicate or El 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. Bishopp, Meredith (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 10/19/17 (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 issued to him/her in the sum of $ 477 .45 .(3) Signed: (4) Note: Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. (5) Su scribed and sworn to before me this 7-In day of '6\itinftber2o L. 0 N\OJA NOTARY PUBLIC OFFICIAL SEAL 1.1 AURA NELSON j My commission expires: Notary Public - State of Arizona • 02r1 MARICOPA COUNTY I (seal) •,....•••••••• II •• ••••• My •• I"••••• Comm. • ••••II•• Expires I•I ••I••••••• Dec. 28,2019 • I•••••••• ! Warrant/Check Number 180022092 if known) (6 Reason for original issue of Warrant/Check (8): Payroll 0 For Services or Goods furnished RK 'MPoliC3FA BOARD 6P COUNTY SU 0 Treasurer's refund/payment El Other: S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc Revised April 2015 A.R.S. 11-632 & 11-644 5,aor Stop Payment Affidavit Business Resources I APPROVED DAT2 II I I A.I.P0 STATE OF ARIZONA RIC BOARD OF SUPERVISORS COUNTY OF MARICOPA MARICOPA COUNTY Demco Inc. , being first duly sworn, upon oath deposes and states: That on the 2 day of MaY , 20 17 , he/she presented to Littleton Elementary School District No. 65, of Maricopa County, for payment, a claim for services rendered or supplies furnished during the month of May , said claim being in the sum of Two hundred and forty seven and 27cents Dollars ($ 247.27 ) in payment of which Littleton Elementary School District No. 65 caused warrant/check number 470097521 to be issued on 11 day of MaY , 20 17 drawn on the warrant/check fund of Littleton Elementary School District No. 65 of Maricopa County, Arizona. Affiant further states that although he/she was informed and believes that the above mentioned warrant/check was regularly issued, the same has never been received, or has been lost. Wherefore, affiant requests that the Governing Board order and the Littleton Elementary School District No. 65 issue to him/her a replacement of said warrant/check number470097521 in the sum of $ 247.27 *Ai% /6; 7Y-- Signatture / -7 Z74 I /7 Subscribed and sworn before me this ( day of ,20 . 11.1111IIII•I=111I.11111=111.1111II•I.11111iiIrabwe Signature of Notary Public SHAWNA LEY ‘,20 /8 Notary Public State of Wisconsin MyComrrlission Expires 03/2013 eAr (Tiv44\<