090617 DUPLICATE WARRANTS 2.PDF

Maricopa County Education Service Agency
INTEROFFICE MEMORANDUM
Maricopa County Education Service Agency
3
TO: Clerk of the Board j () RECEIVED
FROM: CARRIE GUNDERSON AUG 1 0 ?017
SUBJECT: Affidavits — Replacement of Lost /Stale Warrants
MARICOPA COUNTY
DATE: 8/7/2017 CLERK BOARD OF SUPERVISORS
PLEASE FIND ATTACHED AFFIDAVIT/NOTICE OF CLAIM(S) FOR LOST WARRANTS FOR
INCLUSION ON THE NEXT AVAILABLE BOARD AGENDA.
•NI 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 Carrie Gunderson at (602) 372-4833 opt.3 or via e-
mail at garnishmentsmcesa.maricopa.gov . Approved Affidavits may be routed back to the
Maricopa County Education Service Agency at 4041 N. Central Avenue #1200, (12th Floor)
Thank you.
Fund 781
Gay Marie Trabue-Taylor 1 80003473 Dated 7/20/17 $848.28
4041 N. Central Avenue, Ste. 1200, Phoenix AZ 8501 2 • Phone 602-506-3866 • Fax 602-506-
3753
www.maricopa.gov/mcesa Twitter: #mcesaaz Facebook: mcesaaz

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: 0 Duplicate or D 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.
GAY MARIE TRABUE-TAYLOR (1), being first sworn, upon oath deposes and says:
Nmei Iaimant
On or about 7/20/17 (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/che4 be issued to him/her in the sum of $ 848.28 .(3)
(4)
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
scribed and sworn to before me this -1 day of 20 .
imission expires:
seal)
Warrant/Check Number 180003473
if known 6
Original Date of Issue 7/20/17
(if known) (Z)
Reason for original issue of Warrant/Check (8):
El Payroll
O For Services or Goods furnished RK, MA BOARD OF 'A COUNTY- SUPERVISORS
O Treasurer's refund/payment
I=1 Other:
SAPROCESSES \Warrants - Duplicate or Stale \02 Forms\Warrants Checks notice of claim - Copy.doc A.R.S. 11-63213( 11-644
Revised April 2015