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INTEROFFICE MEMORANDUM Ilaricopa County School-Superintendent's Office TO: CLEWKOE 00ARD RECEIVED FROM: .W1i1Tie Thompson AUG 1 8 2017 SUBJECT: Affidavits MARICOPA COUNTY DATE: 8/16/2017 CLERK BOARD OF SUPERVISORS Prease find attached 3 Affidavit/Xotice of Craim(s)for Cost warrants for inc fusion on the next avada6 Ooard agenda The attached item(s) have been researched to ensure that the warrant(s) in question have not been cashed- or previous(); re-issued: The original. warrant(s) have had a stop payment done. If you have any questions, precise contact Willie Thompson at 372-1244 or via e-mail at mthompson@mcesa.maricopa.gov . Approved - Affidavits may be routed back to the Superintendent of School Einance Division at 4041 N. Central Avenue #1200, ( 12 th Eloor) Thankyou. #60 JfIGLET CYNTHIA EVA KUDDELL $889.09 #65 LITILETON MAXDO1 raIVENS $1000.52 Schools Affidavit/Claim Form Appiicaiiun -Fur 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. RUDDELL, CYNTHIA EVA (1), being first sworn, upon oath deposes and says: Name/Claimant On or about Y1'03/0 (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 $ 889.09 .(3) Signed: 11( (4) (5) Su))scribed and sworn to before me this day of _C-2, -20 /7. NOTARY PUBLIC OFFICIAL SEAL LYNE-1-"TL --'1Ecu'VVART My mmi7ion expires: Notary Public - State of AriZOrLa a) / 7 90 My MARICOPACOUNTY COMM. EXpiltiS Sept, 17,2020 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 180005762/60522004 APPROVED (if known) (6) Original Date of Issue 08/03/2017 7 I I (if known) (7) /4.1.1. Reason for original issue of Warrant/Check (8): CLERK. MARICOPA BOARD OF COUNTY SUPERVISORS Payroll 0 For Services or Goods furnished 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 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: 0 Duplicate 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. P. . )7 6. 13)v eh (1), being first sworn, upon oath deposes and says: Name/Claimant On or about jab./ (date)(2) a warrant/check was issued to the above named perso(n/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/checj5b7ssued to him/her in the sum of $ /ey,e,5-q .(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. ubscribed and s o n to bifore me tVis 1 I day of ,t-Iu_Sct--4 20 NOTARY PUBLIC Anamaria QuintanIlla Notary Public My commission expires: MM y a Comm. rIcPaCExpires u n tY A 0 6 5 -7 5n a l r_f;iS — ?-0 t (seal) Warrant/Check Number /goo623(1? 510 (if known) (6) Original Date of Issue "747 —7 I APPROVED (if known) (7) " / • Reason f r original issue of Warrant/Check (8): ayroll CLERK BOARD OF SUPERVISORS El For Services or Goods furnished LO PA COUNTY 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