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INTEROFFICE MEMORANDUM Maricopa County Education Service Agency (aka Maricopa County Superintendent of Schools Office) RECEIVED 4,\) TO: CLERK OF THE BOARD JUL 3 1 2017 V9 FROM: Terri Ysaguirre MARICOPA COUNTY SUBJECT: Affidavits — Replacement of Lost Warrants CLERK BOARD OF SUPERVISORS DATE: 7/26/2017 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, pledse contact Terri Ysaguirre at 602-372-1245 or via e-mail at theresa.vsaguirre@mcesd.Mailcopa.gov . Approved Affidavits may be routed back to the Superintendent of School Finance Division at 4041 N. Central Avenue #1200, (12th Floor) Thank you. •=1) #45 Fowler Laura Cristina Sandoval $283.50 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. SANDOVAL, LAURA CRISTINA (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 06-30-2017 (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 b issued to him/Aer in the sum of $ 283 .5p .(3 ) Sign (4) (5) Subscribed nd sMrn to before me this day of 20(7. OFFICIAL SEAL My c mmission expires: Notary LAURA Public G. LOZOYA - Arizona - My MARICOPA Commission COUNTY Expires (seal) JANUARY .1111•111•1111/4.001•11..".” 25. 2019 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 45227924 (if known) (6) APPIICIVED Original Date of Issue 06-30-2017 OA (if known) (7) DAT Reason for original issue of Warrant/Check (8): LERK BOARD OF SUPERVISORS Payroll MARICOPA COUNTY 0 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