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RECEIVED INTEROFFICE MEMORANDUM NOV 2 0 2017 MA-FtteePeeliNlY Maricopa County Education Service Agency (aka CLERK BOARD OF SUPEIWISORS Maricopa County Superintendent of Schools Office) TO: CLERK OF THE BOARD FROM: Terri Ysaguirre SUBJECT: Affidavits — Replacement of Lost Warrants DATE: 11/17/2017 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 terrLysaguirre@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. #68 Alhambra Elem Desiree Dancer #480038012 $90.00 #90 Saddle Mountain Phoenix Pumps #480001008 $850.47 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. DESIREE DANCER (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 10/25/2017 (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/ch d to him/her in the sum of $ 90.00 •(3) Signed: (4) (5) Subscribed and sworn to before me this IP day of 1\)15Vernigtr 201 -7 . 10S\ 4Ci (ICA NOTARY PUBLIC My commission expires: JOSIE PRICILLA GARCIA 1012512017 01,tcy- l/c s 26161 NOTARY PUBLIC - ARIZONA (seal) MARICOPA COUNTY YPP56,11WPFIERBW9W2etW 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 480038012 APPROVED (If known) (6) Original Date of Issue DATA N 2 U LW/ (If known) (7) 10/25/2017 , —ILI Al, AP Reason for original issue of Warrant/Check (8): ...t157RK. -14-rw./f MARICOPA BOARD OF COUNTY SUPER \ 0 Payroll 0 For Services or Goods furnished REIMBURSEMENT RI Other: REIMBURSEMENT 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 APPROVED Schools Affidavit/Claim Form DATR NOV/0 20 BOARD OF SUPERVISORS I 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 shoot which Is page 2 of this form. )4, Pi— —amo/Gfaiman" * (I), being first sworn, upon oath deposes and says: On or about alAk.1 ic2\-77 ,date, )(2) a warrant/check was issued to the above named persori/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, pi 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 5,11ofln is due and owiD9,-and the applicant requests that a replacement , warrantictrL“ issuectier in the sum of $ 0(3) .X Sig ect: (4) (5) Sy, -bed and sworn to before me this \ day of Ck/ei ilJty/ 20 I . /lova \2t NOTARY PUBLIC PAMELA 0 HAM My commission expires: Notary Public - Arizona c 1 '2 Maricopa County My Comm. Expires Jan 1, 2020 (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 e4 k:(cc:S. cao rn, (if known) (6) * (i) cGss5- —&7 Original Date of Issue i -- -ir-. (if known) (7) 1) Id ;A--n Reason for original issue of Warrant/Check (8): 0 Payroll EI-1(3-r Services or Goods furnished I9 Ph j71 / 0 Other: r\\ ,, di L 1-q) 0 , 1 b in (b ) ru ca, v S:\PROCESSESAWan-ants Revised June 2015 - Duplicate or Stale\02 Forms \Scbools\Schools-Warrants Checks notice of dalm.doc A.R.S, 11-632 & 15-999