102517 DUPLICATE WARRANTS 4.PDF

INTEROFFICE MEMORANDUM
TRANSMITTAL
TO: CLERK OF THE BOARD OF SUPERVISORS
FROM/RETURN TO: d O:)45 /-9V divic
DEPT: )V6 PHONE: (6,0,- 5
sapeavogr hi We
DATE: 97-2717 36v c " am4/7
Please find attached the following Affidavit(s) / Notice of Claim(s) for duplicate or
stale-dated warrants/checks for inclusion on the next available Board of
Supervisors' agenda:
NUMBER OF DUPLICATE WARRANTS/CHECKS ATTACHED
NUMBER OF STALE-DATED WARRANTS/CHECKS ATTACHED
Type* Name on Affidavit Warrant # Amount
3100c,U -7Kb
iT: 0, hi .,s- - - oCh-eC
3-/D09,5,9J7 5q i aD
*Type – please enter the code for the following type of re-issued warrant requested
• D=Duplicate Warrant (within one year of date of issuance)
• SD=Stale-Dated Warrant (over one year, but not more than 2 years old)
•
Circle response:
1. Has this warrant been cashed? yes 0:_o•
2. A stop payment has been placed on this warrant? (ye no
3. If a Stale-Dated Warrant, is this date w/in 2 years of issuance? yes no n/a

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: Duplicate or El Stale-Dated (definitions are on page 2)
STATE OF ARIZONA Note: Numbers on this form correspond to
COUNTY OF MARICOPA numbers on the Instruction sheet which is
Moe 2 of this form.
CHRISTOPHER LAM PERT (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 01May2017 -- (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 $ 193 .00 .( 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 fled a-ntkpNOrn t before me this LW' day of 20_12.
-OffICIAL SEAL
N MARY PnELIC Spenser Waqwe
NOTARY PUBLIC
My commi sion expires: STATE OF NEVII,M9C
My Commission Expires:
Warrant/Check Number 370022780
(if known) (6)
Original Date of Issue 01-May-2017
(if known) (7)
Reason for original issue of Warrant/Check (8):
ERK, BOARD OF SUPERVISORS
0 Payroll MAR 'CO PA CaUNTY
0 For Services or Goods furnished
0 Treasurer's refund/payment
Other: REFUND-JUSTICE COURTS-DOCKET# CT2016130231

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for 0 Duplicate or 0 Stale-Dated (definitions are on page 2)
STATE OF ARIZONA Note: Numbers on this form correspond to
COUNTY OF MARICOPA numbers on the Instruction sheet which is
oaae 2 of this form.
JACOB MONTANEZ (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 31-May-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/checKbe issued to him/her in the sum of $ 591.00 .(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
ibed and sworn to before me this day of 20/7 .
..••I••••-•-""
i OFFICIAL SEAL
JESSICA M. PELTON j
Notary Public - State of Arizona
MA commission expires: My MARICOPA Comm, Expires COUNTY Oct, 23, 2020 !,
-}4 0.I •••••. 111111•1 4..0 0/..1008•••••.11.• I•1111•./.0. (seal)
Warrant/Check Number 370025212
(if known) (6)
Original Date of Issue 31-May-2017
(if known) (7)
Reason for original issue of Warrant/Check (8):
D Payroll CLERK, BOARD OF SUPERVISORS
MARICOPA COUNTY
D For Services or Goods furnished
El Treasurer's refund/payment
Other: REFUND-JUST10E COURTS-DOCKET# CT2016233644
2o11,

INTEROFFICE MEMORANDUM
Maricopa County Education Service Agency (aka
Maricopa County Superintendent of Schools Office)
RECEIVED
SEP 2 9 2017
TO: CLERK OF THE BOARD MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS
FROM: Terri Ysaguirre
SUBJECT: Affidavits — Replacement of Lost Warrants Ott(
DATE: 9/28/2017
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.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.
#402 West-MEC Julia Anderson #480015643 $2,095.07

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.
3-11, ia., /incie rs6 (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about Al.*/US-f- t 5 / r7 (date)(2) a warrant/check was issued to the
above named person/entity i n 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 $ 0 ci 5, o 17 .(3)
Sign (4)
(5) Subscr ed and sworn to before me this ..25 Wvi day of 54421k1p 20 /7.
NOTARY PUBLIC
OFFICIAL SEAL
My commission expires: DEANNA JEAN MARKHAM
Commission #188810
z/-aa-/8 Notary MARICOPA Public State couNry of helacins (seal)
My corm, expire* April 22. 201$
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) LH' Do 151p 1-1-3 -, ...
Original Date of Issue DATE SEP1 9 2017
(if known) (7) gi/ 5/ I7 -1... ----7c-
Reason for original issue of Warrant/Check (8): MARICOPA COUNTY
0 Payroll
0 For Services or Goods furnished
)4 Other: -h71Ve, I reimburse_rnet
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