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INTEROFFICE MEMORANDUM Maricopa County Education Service Agency (aka Maricopa County Superintendent of Schools Office) RECEIVED SEP 1 1 2017 MARICOPA COUNTY TO: CLERK OF THE BOARD CLERK BOARD OF SUPERVISORS FROM: Terri Ysaguirre SUBJECT: Affidavits — Replacement of Lost Warrants DATE: 9/7/2017 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. #44 Avondale Elem Arizona Dept of Water Resource #470096305 $419.33 #65 Littleton Elem Jordyn Crawford #180007561 $237.68 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, Arizona Dept of Water Resource (1), being first sworn, upon oath deposes and says: Nanne/Claimant On or about May 9, 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/che* be issued to him/her in m of $419.33 .(3) Signed: (4) (5) Subscribed and sworn to before me this I ED day of Akit.L‘I+. 20 \-1 . /31/1-ekga4 (r\ir)EIY) NOTARY PUBLIC gbyi.„di,..../6,416y116.111roiffirM14 - THERESA JOHNSON My commission expires: Notary Public - Arizona 44*-94e'fr— Will, 1. 2-tia) My Comm. Maricopa Expires County May 1, 202(ffi 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 470096305 / 44753037 APPROVED (if known) (6) . . 2 2017 Original Date of Issue 05/09/2017 DAT (if known) (7) a / Reason for original issue of Warrant/Check (8): airr -mali RK,m1341:0R/A:RoDpOir :FcSoU-uP- PNETy RVI.SORS ,—, ,-,_...__11 For Services or Goods furnished Permit/Fee El Other: Permit/Fee S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of cialm.doc Revised June 2015 A.R.S. 11-632 & 15-999 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: ErDuplicate 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. Ne•c‘ Gettk.o C1(1), being first sworn, upon oath deposes and says: Name/Clairl On or about f - c i1 ) IZO 7(date)(2) a warrant/check was issued to the above named person/eritity 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 'ssued to hi /her in t sum of 37, 6, .(3) Signed:( Jraccit• o rd r Arvi (4) Note Please(4ttach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued, (7)1 Subscribed and sworn to before me this 3 6 day of/—k Cp S 1-- 20 1 7 NOTARY PUBLIC Anamarla QuIntanilla ommission expires: Maricopa Notary County, Public A:lions C5&)\ S (71') My Comm Expires 05-1541 (seal) Warrant/Check Number (if known) (6) Original Date of Issue (if known) (7) 7 Reason_fgr-original issue of Warrant/Check (8): K, BOARD OF SUPERVISORS MARICOPA COUNTY I34-or Services or Goods furnished 0 Treasurer's refund/payment 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