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INTEROFFICE MEMORANDUM Maricopa County Education Service Agency (aka Maricopa County Superintendent of Schools Office) RECEIVED TO: CLERK OF THE BOARD SEP. 0 5 2017 FROM: Terri Ysaguirre MARICOPA COUNTY CLERK BOARD OF SUPERVISORS SUBJECT: Affidavits — Replacement of Lost Warrants DATE: 8/31/2017 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. #25 Liberty Elem TTCO Holding Co Inc #470107503 $30.65 #33 Buckeye Elem Anjeline Corchado #180008221 $1,064.55 #05 Isaac Elem Rawhide Western Town & Steak #470107270 $159.20 Schools Affidavit/Claim Form Application for a Duplicate Warrant/Check (definitions are on page 2 STATE OF AR4-Z-6-NA- Note: Numbers on this form correspond to numbers on the COUNTY OF IVIA-RIGGPA Instruction sheet which is page 2 of this form. TIC% 6111- ,fEAS (1), being first sworn, upon oath deposes and says: Name/ laimant On or about 06113 bloi7 (date)(2) a warrant/check was issued to the above named person/en ity 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 $ 30, .(3) Signed: (4) (5) Subscribed and sworn to before me this 22 ° day of 20 )7' . KELLY WALL MY COMMISSION # 12696400 EXPIRES: December 5,2025 My commission expires: Baxter County /2 It25 (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 (if known) (6) II . 170/0 75-03 / 0755qq9Y5' Original Date of Issue (if known) (7) 60113101017 APPROVE Reason for original issue of Warrant/Check (8): Payroll For Services or Goods furnished CLERK, B07111175-07STJPERVISICIRS 0 Other: MARICOPA COUNTY 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 111 11111I 111 II::iniccitli to numbers on the COUNTY OF MARICOPA 11.11ni 1111 page 1111 11rii (\lidkci2V-61‘ 1'00\ (1), being first sworn, upon oath deposes and says: On or about 03/26r7 (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 $ J Signed: (4) (5) Subscribednd sworn to b fore me this 31 day of 20 /1. 1 ov-k NOTARY PUBLIC iiii OFFICIAL SEAL 1.•C . SANDRA APONTE i My corn I sion. xpires: Way Public- state alAtteata // PO 14. MARICOPACOUNTY I , MO My Comm. Expires Axil 11, 2020 j (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 1.41-10( Z ri 0 (if known) (6) 0 7 APPROVI Original Date of Issue DAT: SEP 5 2017 (if known) 7 IINMPWAIMI," Reason for original issue of Warrant/Check (8): MAR1COPA COUNTY S CI Payroll CI For Services or Goods furnished U'Other: OV1-66‹ CUS Wfbnq addir-Lcs checd< CC w cLS n-eycr raurn-ed s-Cnd er SAPROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc Revised June 2015 A.R.S. 11-632 & 15-999