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INTEROFFICE MEMORANDUM Maricopa County Education Service Agency (aka Maricopa County Superintendent of Schools Office) RECEIVED OCT 1 0 2017 TO: CLERK OF THE BOARD CLERK MAR1COPA COUNTY BOARD OF SUPERVISORS FROM: Terri Ysaguirre SUBJECT: Affidavits — Replacement of Lost Warrants tik/ DATE: 10/6/2017 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.vsaguirre@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. #60 Higley Southwest Gas Corporation #470095103 $2,491.55 #44 Avondale Melissa Flores-Salas #170032373 $159.43 #44 Avondale Camaron Hallford #170032383 $146.66 #44 Avondale Evelin Nunez #170032422 $114.60 ,#44 Avondale Sijuola Ade Shabazz #170032442 $109.99 #44 Avondale Jamie Rico #170032436 $126.58 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: 3 Duplicate or 0 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. (1), being first sworn, upon oath deposes and says: ame/Clalmant On or about )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 to him/her in the sum of $ 159. 93 .(3) Signkd: (4) Note: Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was origMally issued. (5) ubscribed and sworn to before me this ,2 /.\-4 day of 00-7A9er 20 1'3' , RY PUBLIC " x>%Y-111-11. AURA NELSON Notary Public - State of Arizona ; My commission expires' MAR1COPACOUNTY Dee.- 91 ( af31 My Comm. Expires Dec. 28,2019 I (seal) Warrant/Check Number 1 1 DD 3,2.31 3 (if known) (6) Original Date of Issue )1- 11•1(p (if known) (7) Reason for original issue of Warrant/Check (8): APPROVED Payroll DATE, ON 3 2017 0 For Services or Goods furnished 0 Treasurer's refund/payment mnicorA C UNTY 0 Other: S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc Revised April 2015 A.R.S. 11-632 & 11-644 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: El Duplicate or El Stale-Dated (definitions are on page 2) STATE OF ARIZONA Note: Numbers on this form correspond to numbers on the COUNTY OF MARIQOPA Instruction sheet which is page 2 of this form. ( 1), being first sworn, upon oath deposes and says: ame/Claimant On or about 11- 1 1 - 1(to (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 $ 1 L1 49 • 1140 43) 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) Subscribed and sworn to before me this c9- day of ((_;d13\aer 20 11 . NOTARY PUBLIC i/05 OFFICIAL SEAL I AURA NELSON My commission expires: 1,%l itgffl Notary Public - State of Arizona 'Dec 94f3te7 My MARICOPACOUNTy Comm. ExpIrss Dec, 28, 21!3I) Warrant/Check Number (if known) (6) ipo 3P3`33 Original Date of Issue 11 - 1 1 - 140 (if known) (7) Reason for original issue of Warrant/Check (8): 0. Payroll APPROVED LI For Services or Goods furnished 0 Treasurer's refund/payment 0 Other: S:\PROCESSES\Warrants - Duplicate or Stale\02 Fortns\Warrants Checks notice of claim - Copy.doc Revised April 2015 A.R.S. 11-632 & 11-644 Application for a Duplicate or Stale-Dated Warrant/Check P1-1 Affidavit/Claim Form This application is for: 0 Duplicate or El 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. Ve 11V Ngefe7 (1), being first sworn, upon oath deposes and says: ame/Cialmant On or about 11- 11.1(0 (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 $ I ) q • GoD .(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) Subscribed and sworn to before me this (-11-1/\ day of D (4119-er 20 )1'. NOTAIJIRIC Isatitausi orsMi ars. Ur: I AURA NELSON M ommission expires: • Notary Public - State of Arizona ; . I )61 MARICOPA COUtign My Comm. Opires Dec. 28, 2019! • • 7... • • +•••• • • Mm• • • MO • • 1.1•11• • ••=1 moo • ims• • • • IMMO • • Imle Warrant/Check Number (if known) (6) 11 01) 3 P Lt g P Original Date of Issue (if known) (7) Reason for original issue of Warrant/Check (8): 10 Payroll I APPROVED LI For Services or Goods furnished 0C14 3 2017 O Treasurer's refund/payment O Other: S:\PROCESSES\Warrants - Duplicate or Stale \02 Forms \Warrants Checks notice of claim - Copy.doc Revised April 2015 A.R.S. 11-632 & 11-644 Application for a Duplicate or Stale-Dated Warrant/Check tt Affidavit/Claim Form This application is for: El Duplicate or 0 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. (1), being first sworn, upon oath deposes and says: On or about (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 $ )09.9 9 .(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) Stitilscribed and svyorn to before me this 3rd day of (:)-1-77/z)Z2-av 20 / 7. NOTARX PUBLIC orAL SEAL AURA NELSON j My cpThmission expires: i 12( Notary Public - State of AriZOna \%eQ. -tar. • my MARICOPA Comm. Expires COUIYTY Deo. 28, 2019 1.1 (sea l) Warrant/Check Number I -) 0 0 3 p g (if known) (6) Original Date of Issue 1 1 - 11- 1(4) (if known) (7) Reason for original issue of Warrant/Check (8): Ig Payroll APPROVED El For Services or Goods furnished 11 DAATT=-• 0 C 3 2017 El Treasurer's refund/payment VISO T.,5 0 Other: S:\PROCESSES\Warrants - Duplicate or Stale \02 Forms\Warrants Checks notice of claim - Copy.doc Revised April 2015 A.R.S. 11-632 & 11-644 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: 121 Duplicate or 0 Stale-Dated (definitions are on page 2) Argakabc STATE OF Note: Numbers on this form correspond to numbers on the COUNTY OF Miklifeef Instruction sheet which is page 2 of this form. Lk F- (L I C (1), being first sworn, upon oath deposes and says: Name/Claimant On or about n• 1 (p (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 $ 43) ii Signed: 01, v‘.,.-C t (4) Note: Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. Lc=1.LE (5(= ik/ e vOc_lct COu r)LLI 11 r (5) Subscribed and)svkforn to before Me this day of Cr b cI 20 i 4 • NO PUBL BROOKE CARTER NOTARY PUBLIC My commission expires: ) STATE OF NEVADA 0 a Appt. No. 17-259A-1,,, My Appt. Expires JuneW,WV1 Warrant/Check Number 1 1 no3 (43(0 (if known) (6) Original Date of Issue I I (,0 (if known) (7) Reason for original issue of Warrant/Check (8): Et Payroll 0 For Services or Goods furnished 0 Treasurer's refund/payment 0 Other: s:\PRoCEssES\Warrants - Duplicate or Sta102 Forms\Warrants Checks notice of claim - Copy.doc Revised April 2015 MU. 11-632 81.11-644