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INTEROFFICE MEMORANDUM 911arkopa County School' Superintendent's RECEIVED TO: CLERX OE TJ-I?E 00.ARD OCT 2 7 2017 FROM: 'Thompson MARICOPA COUNTY SUBJECT: Affidavits CLERK BOARC OF CUPERVISORS DATE: 10/26/2017 Pkase find attached 1 Affidavit/Notice of Cfaim(s)for lost warrants for inclusion on the ne4 avada6k Ooard agenda '\1 The attached item(s) have deen researched to ensure that the warrant(s) in question have not 6een cashed or previously re-issued The original warrant(s) have had a stop payment done. you have any questions, please contact Millie Thompson at 372-1244 or via e-mail at mthompson@mcesa.markopa.gov . Approved Affidavits may 6e routed 6ack to the Superintendent of School - finance Division at 4041 W. Central- Avenue #1200, ( 12 th 'Floor) Thankyou. #95 VEE.7 I1 CREEK SOLID GROVWD E,YPERPRISES $2326.42 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. IT) bpikkiD ekiiknens (1), being first sworn, upon oath deposes and says: Nam e7m Clai nt On or about 11 \t (date)(2) a warrant/check was issued to the above named pers n/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 $ I -3)- acc• 43 .(3) Signed: (4) (5) S bscrib and sworn to before me this day of NOTARY-PUBLIC My commsionr.,, ,,,,, 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 \ACSDDD?)‘ S5 \ b tiOS 1 1 (if known) (6) Original Date of Issue COI ti (if known) (7) Reason for original issue of Warrant/Check (8): APT 7 El Payroll OCT' 0 2017 g For Services or Goods furnished DAT 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