Extracted text (via pymupdf_layout)
4614 characters
RECEIVED OCT 1 6 2017 INTEROFFICE MEMORANDUM 0 UNFTY Maricopa County Education Service Agency (aka CLERK BOARD OF GLIPERVISOF-13 Maricopa County Superintendent of Schools Office) TO: CLERK OF THE BOARD FROM: Terri Ysaguirre SUBJECT: Affidavits — Replacement of Lost Warrants DATE: 10/13/2017 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. #44 Avondale Elem Benjamin Karren #170032398 $215.01 #44 Avondale Elem Teresa D Sims #170032444 $1,046.12 Application for a Duplicate or Stale-Dated Warrant/Check 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. 41-11,-, V.(„-cs-r-cr. (1), being first sworn, upon oath deposes and says: Nam/Claimant On or about P(ui -, 1)cr- 10 ( 6 (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 $ P15.0/ 43) Signed: 13=1 (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) bscribed„and sworn to before me this \ day of Cchloe,r- 20 1 -9-. (iy,6 -hy_Y _ Jolene Osuna TARY P C Notary Public Maricopa County, Arizona My commission expires: My Comm. Expires 02-15-2021 I) Warrant/Check Number loo339)3 if known) (6 Original Date of Issue if known) (7 DA IZU LEM Reason for original issue of Warrant/Check (8): Payroll ERK, BOARD OF SUPERVISORS ID For Services or Goods furnished LI Treasurer's refund/payment El 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 Ef Duplicate or 0 Stale-Dated (definitions are on page 2) STATE OF ARFZ-ON-A 1441544.74" Note: Numbers on this form correspond to numbers on the COUNTY OF Instruction sheet which is page 2 of this form. tIFAISICCTD"- (1), being first sworn, upon oath deposes and says: NamiegVC4:6. 6 fil On or about 11 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 $ I , (Ay . )9 .(3) Signed: dA.A...-c.A1-6.-1). )S--t.AiLL) (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 .5-11'-' day ofoige.,Iv htt- 20 /1 . Z=v05 ,„.,.I\` .LL 10 if>, ' i 40,, \vo•auN E4-• s, NOTARY PUBLIC My commission expires: E ... ig I. 0 1400`„r. . 131.1.., : 0 = ()1/4//0/002.6 rij ::,.../ 4, iTzt..z.... (seal) ',. -9)............,,,k Warrant/Check Number ' 9 (111111W vvr-tvo (if known) (6) I -7003P4" Original Date of Issue Alf known) (7) Reason for original issue of Warrant/Check (8): a Payroll Rk, BOARD OF SUPERVISOR'S O For Services or Goods furnished MAPICOPA COUNTY O Treasurer's refund/payment O Other: SAPROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc Revised April 2015 A.R.S. 11-632 & 11-644