102517 DUPLICATE WARRANTS 6.PDF

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: 10/3/2017
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.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.
#66 Roosevelt Leticia Flores #170065410 $402.81
#66 Roosevelt Leticia Flores #180014177 $483.50

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.
Leticia Flores (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 6 9//y/90/7-- (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 $483.50 .(3)
Signed: ,24 i ic-) 4 ct f-70 T e,5 (4)
(5) Subscribed and sworn to before me this c:3-Ce" day of ,cep-itilIbtr 20
))In
NOTA PUBLI
Notary Public State of Arizona
My commission expires: Maricopa County
af / (X)c)--e.) Jocelyn My Commission Castillo Expires 12/08/2020 (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 180014177 7 77 n G 4' E J
(if known) (6)
Original Date of Issue 09/14/2017 DA—
(if known) (7)
ReasorVor original issue of Warrant/Check (8): MARICOR; COUNT!;
al" Payroll
El For Services or Goods furnished
ID-Tither: /fraW- 12-e_e-a-A-e-at ,.f/Cte
RECEIVED
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc OCT 0 2 2017
Revised June 2015 A.R.S. 11-632 & 15-999
MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS
oktr

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.
Leticia Flores (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about Oy41-47e/7 (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 $ 402.81 .(3)
Signed: (4)
(5) Subscribed and sworn to before me this acr‘day of S-ecW 20 1R-
NOTARY PUBLIC
Notary Public State of Arizona
My commission expires: Maricopa County
lab:Vac:0C) 71 Jocelyn C,D111MiSSiOn Castillo Expires 121061202 (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 170065410
(if known) (6)
Original Date of Issue 04/27/2017 2017
(if known) (7) DAT 0C1)) 3
Reason for original issue of Warrant/Check (8): RK, BOARD- CIF s-urYtr10Frs
Payroll MARICOPA COUNTY
CI For Services or Goods furnished
IPVOther: Jy1L I. 4 44,-, „7- Avitr
RECEIVED
S: \ PROCESSES \Warrants - Duplicate or Stale \02 Forms\Schools\Schools-Warrants Checks notice of claim.doc A.R.S.Q.C-(131)AW
Revised June 2015
MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS