112917 DUPLICATE WARRANTS 11.PDF

INTEROFFICE MEMORANDUM
Waricopa County Scfioor Superintendent's Office
TO: CLERK OE DA 0.ARD
FROM: gfrtiffie (Thompson
SUBJECT: Affidavits
DATE: 11/1/2017
Prease find attached 1 Affidavit/Yotice of Cfaim(s)for Cost warrants for incrusion on
the ne.v avaiCa6fe Ooard agenda
The attached item(s) have been researched to ensure that the warrant(s) in
question have not been cashed or previousCy re-issued
The original-warrant(s) have had a stop payment done.
If you have any questions, p&ise contact Millie Thompson at 372-1244 or via e-mad at
mthompson@mcesa.maricopa.gov . Approved Affidavits may be routed back to the
Superintendent of School - Finance Division at 4041 7V Central Avenue #1200, ( 12 th
Ethor) Thankyou.
#44 AVONDALE TAWAR3 S DICKINSON $624.00
RECEIVED
NOV 0 3 2017
MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: 10 Duplicate or E] 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.
Tamar oi iatnsbY\ (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 2 4 - q- (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 $ 99 .Db .(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) Sub§Fribed and sworn to before me this 2-14" day of StpleMbee 20 rt
NOTARY PUBLIC
OIIAL AL 1
My commission expires: : Irr e e AURA NELSON
b. , 01 41.1 Notary MAR Public ICOPA -State COUNTY of Arizona (seal)
My Comm, Expires Dee. 28, 2019 !
Warrant/Check Number
(If known) (6) ?DbIOD3,2
Original Date of Issue
(if known) (7)
, ,
Reason for original issue of Warrant/Check (8):
VJr, Payroll
0 For Services or Goods furnished CLERK BOARD OF quo Flo
VARICOPA COUNTY
0 Treasurer's refund/payment
El Other:
SAPROCESSES\Warrants - Duplicate or Stale\ 02 Forms\ Warrants Checks notice of claim - Copy.doc
Revised April 2015 ARS. 11-632 & 11-644