082317 DUPLICATE WARRANTS 4.PDF

Maricopa County — Formal (2017-08-23)

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INTEROFFICE MEMORANDUM
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: 7/27/2017
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 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.
#60 Higley Alana Charnofsky #170077736 $1,119.02
#60 Higley Alana Charnofsky #170078586 $1,118.94
#60 Higley Glenn K Naole #180001187 $79.25
#60 Higley Glenn K Naole #180000719 $107.47

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.
ALANA CHARNOFSKY (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about Le 5 - '7 (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,-le issued to himjfier in the sum of $ 1119.02 .(3)
Signed: (4)
cribed and sworn to before me this do-i-k day of ,filij 20i j.
'UvOtaeWwo
NOTARY PU At opitt4-4\4\ OFFICIAL SEAL I
TAMMY NAVARRO I
My commOsion ex ires: Notary Pubic- State of Anzona I
• - My MARICOPA Comm. Expires COOTIY_ Mardi 51 , Vie ! (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 170077736/60516625
(if known) (6)
Original Date of Issue 06/08/2017
(if known) (7) I APPROVED
Reason for original issue of Warrant/Check (8): DAT 1-1
Payroll
RK, BOARD OF SUPERVISORS
LI For Services or Goods furnished MARICOPA COUNTY
El Other: V
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 Note: Numbers on this form correspond to numbers on the I
COUNTY OF MARICOPA Instruction sheet which is page 2 of this form.
ALANA CHARNOFSKY (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 5 - / 7 (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/che/2 e issued to/hnher in the sum of $ 1118.94 .(3)
Signed: (4)
(5) Sul;iscribed and sworritio before me this day of ,37,AJ2&i 20 11.
dx7z/(4),Qi}aL/ce,4/1.0
NOTARY PUBLI
TAMMY NAVARRO j
r\ltrnrr.s1)-1743ires: Notary Public - State of Arizona
MARICOPA COUNTY I (seal)
My Comm. Expires March 6. 2019j
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 170078586/60517487
(if known) (6)
Original Date of Issue 06/08/2017 1
(if known) (7) APPRO.VED
Reason for original issue of Warrant/Check (8):
Payroll
El For Services or Goods furnished I.
El Other: V Li -7
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 I Note: Numbers on this form correspond to numbers on the
COUNTY OF MARICOPA Instruction sheet which is page 2 of this form.
NAEOLE, GLENN K (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 7//3 2DI -1 (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/chgck.be issued to him/heriin the sum of $ 79 - 25 .(3)
Sigizgcl". (4)
(5) Subscribed and sworn to before me this (.;? Vi\-' day of J 20)7.
v0a,(ip,o)
NOTARY PUBLI
1 401 OFFICIAL SEAL
TAMMY NAVARRO
My commission expires: Notary Risk - State of klzona
(0/40 /9 411kz- .4 MARICOPA COUNTY I (seal)
My Comm, Expires March 6, 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 180001187/60520425
(if known) (6)
Original Date of Issue 07/13/2017
(if known) (7) .9
FPROVIED
Reason for original issue of Warrant/Check (8): DATEA
l71 Payroll
El For Services or Goods furnished AK, BOARD OF SUPERVISORS
MARICCPA COUNTY
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

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.
NAEOLE, GLENN K (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 7/t .3 igOn (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/cheA be issued to hyn/her in It e sum of $ 107.47 43)
A
Signe (4)
1
(5) Subs ibed and sworn to before me this cQS-4--day of _j 201. .
' ilii-'724/D CiaNV(A -0
NCYII ILUBLI
OFFICIAL SEAL
TAMMY NAVARRO
My commi4sion expires: Notary Pubic - State ofAsizona
3/ (oicarD/9 MARICOPA COUNTY : (seal)
•• I•••••••••••••••• •• •••I My •••I Corn. •• I•• Expires I ••I • • March I •••••••• 8, I••• 20191 I•••
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 60520037
(if known) (6)
Original Date of Issue 07/13/2017 A M VIlaV; EL
(if known) (7)
DA
Reason for original issue of Warrant/Check (8):
Payroll LERK, BOARD OF SUPERVISORS
O For Services or Goods furnished MARICOPA COUNTY
O 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