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INTEROFFICE MEMORANDUM Maricopa County Education Service Agency (aka RECEIVED Maricopa County Superintendent of Schools Office) NOV 1 6 2017 MARICOPA COLIKr. CLERK BOARD OF F.ii_JPERVISOPS TO: CLERK OF THE BOARD FROM: Terri Ysaguirre SUBJECT: Affidavits — Replacement of Lost Warrants DATE: 11/16/2017 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 Elem GCON, Inc. #470065078 $6,730.00 #98 Fountain Hills USD Larry D Devine #180019741 $744.55 #05 Isaac Elem Copperstate Fire Protection #480022532 $380.00 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. K‘ h (1), being first sworn, upon oath deposes and says: Name/Claimad On or about 61 I Z.),(4) eQ (1 (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 of $ t (7_, .(3) Signed; (4) (5) SAscribed and sworn to ,before me this (C)-14-\ day of veivo5-^;'' 20 . NOTARY PUBLIC ttOZ '6Z id v sa,!dx3 .wtuo) Xj Awn()) edo3pew My commission expires.; euozpv - 31cind A ,eldN S3M01.5 NA8H1VN (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 (if known) (6) r C4 Original (if Date known) of (7) Issue 144 t1 6 1 0 0 4-'' NM/ .4% ri Inv/ Reason for original issue of Warrant/Check (8): 0 Payroll CLERK. BOARD OF SUPERVISORS MARICOPA COUNTY For Services or Goods furnished 111 Other: SAPROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of clalm.doc Revised June 2015 A.R.S. 11-632 & 15-999 Echeols Affidavit/ Oa Ira Forvin Applicaticin for a IT3Upficate Warrant/Check (definitions aiie on paAe 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 foim. )tiv-forte. co, being first sworn, upon oath deposes and says: nte imant On or about Sepf ,), a01"/ (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 diq sum of $ 8g). 0 .(3) Signed: _ (4) (5) Subscribed and sworn to before me this 24th day of October 20 17 EMYLEE SCHLINK Nolary Public.State of Arizona Maricopa County My commission expires: My Commission Expires January 13, 2018 January 13, 2018 (seal) Note: Please attach a copy of the wan-ant/check if available and/or any other evidence that a warrant/check was originally issued. Warrant/Check Number i-W-coaa63a APPROVED (if known) (6) Original Date of Issue DA NOV 1...7 20 (if known) (7) Reason for original issue of Warrant/Check (8): CLERK, BOARD OF SUPERVISORS MARICOPA COUNTY El Payroll . For Services or Goods furnished Seiro ices. f-tood0 Othe - : 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. Larry D Devine (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 10/05/2017 (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 owing, and the applicant requests that a replacement warrant/check be i tOliim-thekin-the sum_of $ 744 . 55 .(3) Signed: (4) (5) Subscribed and sworn to befor, me thi, A/-7/ day of (-7/714'102,20 / 7. NOTAR PUBLIC JEANETTE R. SIMMONS Notary Public - Arizona MV comm) ion expires: Maricopa County My Comm. Expires Jan 31, 2018 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 98604536 \ , DA NOV1 7 2017 (if known) (6) Original Date of Issue 10/05/2017 (if known) (7) T-IK BOARD 0 , , P EP', "IS MARICOPA C Reason for original issue of Warrant/Check (8): Payroll LI For Services or Goods furnished I=1 Other: SAPROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc Revised June 2015 A.R.S. 11-632 & 15-999