112917 DUPLICATE WARRANTS 7.PDF

Maricopa County — Formal (2017-11-29)

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INTEROFFICE MEMORANDUM
Maricopa County Education Service Agency (aka
Maricopa County Superintendent of Schools Office)
TO: CLERK OF THE BOARD
FROM: Terri Ysaguirre
SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 10/30/2017
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.
#214 Tolleson Union Norma Cuevas De Sabillon #180021037 $591.35
#05 Isaac Elem Treasures 4 Teachers #480008946 $3,750.00
RECEIVED
OCT 3 1 2017
MARICOPA cougr.•,'
CLERK BOARD OF SUPERVISORS

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.
Norma Cuevas De Sabillon (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about October 13, 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 issued to him/her in the sum of $ 591 . 35 .(3)
Signed: ,U1L; (4)
(5) Sypscribed and sworp to before me this 21. 40 day of Oc-frAge K- 20 /1- .
LYNETTE STARK
My commission expires: Notary Pone- stste amnia
My Commission MARICOPA Expires COUNTY Juno 15, 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 214742603/180021037
(if known) (6)
Original Date of Issue 10/13/17
(if known) (7)
Reason for original issue of Warrant/Check (8):
IU Payroll
LI For Services or Goods furnished HUARD CF SLIFF I , VICC't-S
D Other: vgRhMPA
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

INTEROFFICE MEMORANDUM
Maricopa County Education Service Agency (aka
Maricopa County Superintendent of Schools Office) RECEIVED
NOV 22 2017
MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS
TO: CLERK OF THE BOARD Iceti
FROM: Terri Ysaguirre
SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 11/20/2017
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 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.
#05 Isaac Elem Treasures 4 Teachers #480008946 $3,750.00

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.
—1---CeaSLer-cx ie_rid-v2r3 (1), being first sworn, upon oath deposes and says:
Name/CTaimant -
On or about 7 / 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 in the sum of $ .(3)
Signed: 5isaclev> (4)
(5) Subs,cri.bed and sworn to before me this )0 day of NO Vetliber 20 /
NOTARY PUBLI
My commission expires: CHERYL ANN MANGOTICH
og.D-0/6 Notary Public Arizona (Seal)
Maricops County
• •
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) Z— — 66.— (// -)69-1L0
Original Date of Issue —1 /.a i
(if known) (7) 1
Reason for original issue of Warrant/Check (8):
1E1 Payroll APPRO E
)gr For Services or Goods furnished DAT I/ to,v
LI Other: erL - TM
- AK BOAR r Curcn VIC, OR S
MARICOPA COUNTY
SAPROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claincloc
Revised June 2015 A.R.S. 11-632 & 15-999