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RECEIVED 146 AUG 2 8 2017 INTEROFFICE MEMORANDIJM MARICC COUNTY CLERK BOARL SUPERVISORS 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: 8/24/2017 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 theresa.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 AZ Dept of Water Resource #470096306 $102.91 #44 Avondale Elem Matthew Rowe #180007699 $202.12 #9 Wickenburg Aaron Urlaub #470021833 $160.00 #60 Higley Unified Superstition Farm #470094071 $1,098.87 Schools Affidavit/Claim Form Application for a Duplicate Warrant/Check (definitions are on page 2) STATE OF ARIZONA Note: Numbers on this form correspond to numbers on the COUNTY OF MARICOPA Instruction sheet which is page 2 of this form. Arizona Dept of Water Resource (1), being first sworn, upon oath deposes and says: Name/Claimant On or about May 9, 2017 (date)(2) a warrant/check was issued to the above named person/entity in the amount as stated below. Such warrant/check was either never received or was subsequently inadvertently lost or destroyed and there is no reasonable probability of its being found or presented for payment, or it was not presented for payment within one year after the date of issuance. Therefore, under penalty of perjury, claimant hereby affirms that this claim is correct and the amount shown is due and owing, and the applicant requests that a replacement warrant/check be issued to him/her irtlile$um of $ 102.91 .(3) Signed: (4) (5) Subscribed and sworn to before me this \I-04 day of 3-kiqz-4-- 20 \t. NOTARY PUBLIC THERESA JOHNSON My commission expires: Notary Public - Arizona Maricopa County -may4,284+- My Comm. Expiretaiat)1, 202 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 470096306 / 44753038 Of known) (6) Original Date of Issue 05/09/2017 (if known) (7) r /7-7x .tu7 Tal )Thg ft Reason for original issue of Warrant/Check (8): DAT, 111 Payroll For Services or Goods furnished Permit/Fee AK, BOARD OF SUPERVISORS MAHIWVA OtJNTY 111 Other: Permit/Fee 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 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: El Duplicate or El 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. Rot3e..no Name/Cf, ft-1-4-ke (1), being first sworn, upon oath deposes and says: aimant On or about S- )0 - Ir (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 $ PO I .(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) Subscribed and sworn to before me this day of 20 OFFICIAL sex: AURA NELSON stiieppexpivesbf Arizona gmm_ezp RICOPIT=Ttt Y : (seal) °111:MMTEXpir135-13e' Y , 21119 Warrant/Check Number (if known) (6) ) ?Co p-N.099 Original Date of Issue (if known) (7) - A_P_PROVED Reason for original issue of Warrant/Check (8): a Payroll CLERK, BOARD OF SUPERVISORS 0 For Services or Goods furnished MARICOPA COUNTY El 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 WICKENBURG UNIFIED SCHOOL DISTRICT NO. 9 40 W. Yavapai, Wickenburg AZ 85390 Phone (928) 668-5350 Fax (928) 668-5390 41 ci inmrioNis — CHILDREN AFFIDAVIT damn litriattiD being first duly sworn, upon oath deposes and says: That on the 13 day of 20 I, he presented to Wickenburg Unified School District #9 Maricopa County, for payment, a claim for services rendered or supplies furnished during the month of (said claim being the sum of One hunlyrd Dollars ($ 0 , tre9 ) in payment of which the Superintendent of Schools caused Warrant # 14700 Z to be issued on ,20 / , drawn on the g5 fund of Wickenburg Unified School District #9 of Maricopa County, Arizona. Affiant further says that although he 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 a duplicate of said Warrant # lb Z 1933in the sum of $ 416 ' Signature: Subscribed and sworn before me this ir.14- day of AL.-t31,t4-, 20 l1 Notary Signature Commission Expiration Date Hefty PACHIIIE Rao - ANN Stab clIktmna ZEMER APPROVED MAFUCOPA COUNTY Al 28 7n17 My October Commission 30, 2010 Expires Following Notary approval please return original affidavit to: CLERK, BOARD OF SUPERVISORS Wickenburg Unified School District MARICOPA COUNTY Accounts Payable 40 W. Yavapai Street Wickenburg, AZ 85390 pO/ )6 6z( N1,0 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. Superstition Farm (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 05 1 bal at:0 ti (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 $ 1098.87 .(3) Signed: (4) (5) Subs‘ibedand sworn to before me this day of a 20 / CRISTINA D'ACQUISTO NOTARY PUBLIC - ARIZONA MARICOPA COUNTY My commission expires: My November Commission 4, 2018 Expires it- (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 470094071 (if known) (6) P Original Date of Issue 05/02/2017 AU - 2 8 2017 (if known) (7) Reason for original issue of Warrant/Check (8): ID Payroll CLERK, MARICOPA BOARD OF COUNTY SUPERVISORS CI For Services or Goods furnished Other: lICX.) 0 c SAPROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc Revised June 2015 A.R.S. 11-632 81.15-999