092017 DUPLICATE WARRANTS 3.PDF

INTEROFFICE MEMORANDUM
Maricopa County Education Service Agency (aka pid
Maricopa County Superintendent of Schools Office)
RECEIVED
TO: CLERK OF THE BOARD AUG 2 4_2017
FROM: Terri Ysaguirre MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS
SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 8/22/2017
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 theresa.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.
#66 Roosevelt Candra Allen #470106610 $49.00
#68 Alhambra Mackenzie A Ramirez #180004446 $380.95
#216 Agua Fria HS Priscila Arroyo #170076886 $50.00

AFFIDAVIT APP OVED
9114 Arl
STATE OF ARIZONA
CLERK, BOARD OF SUPERVISORS
COUNTY OF MARICOPA MARICOPA COUNTY
Candra 4- I ten , being first duly sworn, upon oath deposes and says:
That on the day of Jtk.AP, 20 II, he presented to 0056veit SCAllol
District of Maricopa County, Arizona, for payment, a claim for services rendered
or supplies furnished during the
month of AA.c,1 \w\-‘-' 2011, said claim being in the sum of
- Dollars, ($ 41 61,0 ) in payment of which the
Superintendent of Schools caused his/her Warrant Number '41 OIDt 0(i) D to be
issued on , 20(1 , drawn on the Fund of VoiseueA k- SJ/tooA
District of Maricopa County, Arizona.
Affiant further says that although he/she was informed and believes that the above
mentioned warrant was regularly issued, the same has never been received, or has
been lost.
WHEREFORE, affiant prays that the Board of Supervisors order and the
Superintendent of Schools issue to him/her a duplicate of said Warrant Number
in the sum of
Subscribed and sworn to before me this Le day of Proc)--s-Jr ,20
NOTARY PUBLIC
My commission expires: b`-- - 0 2.02k
Following approval please return this affidavit to the Maricopa County rSatacil—Rupar.iptefideR4e-Qffiee--
JANET L. HART
Notary Public- State of Arizona
MAR ICOPA COUNTY
My Commission Expires
March 1, 2021

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.
MACKENZIE ANNE RAMIREZ (1), being first sworn, upon oath deposes and says:
Name/Claimant
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 Ato be issued to him/her in the sum of $ 380 . 95 43)
Signed: 7 / /0('7d 1 (4)
Subcrib- day of AUGUST 20 17 .
; t(,r - MONICA ORVAL LOPEZ SEAL !
/.;! i ,_m *lir/ Pubric- Stets c: Arizona ;
NOTARYUBLI , i.,, MARICOPACOUNTY !
If" My Comm. &pinta 114 14, 2018 !
...... Mot • • sm. OM • • 0I011. MN ...1.0....010....• ..... ...... • ....•
My commission expires:
(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 1 - 1 000 q Y(4(>
(if known) (6)
Original Date of Issue
(if known) (7) -7 - al - i 7 A TRIt 1`,71 WIG #11 It r lEll iiI
Reason for original issue of Warrant/Check (8):
El Payroll
0 For Services or Goods furnished CLERK, MAR BOARD , COPA OF COUNTM SUPERVISORS
0 Other:
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

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.
Priscila Arroyo (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 6/1/2017 (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/check be issued to him/her in the sum of $50.00 .(3 )
.PY-1/—"‘/ (4)
(5) Subscribed and s orn to before me this day of At4 tfr 20 1)
NOTARY PUBLIC .A-aua. OFFICIAL SEAL
rd, BLANCA PERDOMO
i 1;• Notary Pook- State of Arizona
My commission expires: MARICOPA COUNTY !
-€44424;44. • rott• My Comm. Expire,s April 27, 2021 i (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 216708868
if known) (6 11141 VII frit L.I•
Original Date of Issue 6/1/2017
(if known) (7) DA-T
Reason for original issue of Warrant/Check (8):
Payroll CLERK, MARICCPA BOARD OF COUNTY SUPERVISORS
For Services or Goods furnished
El Other:
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