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INTEROFFICE MEMORANDUM Waricopa County School -Superintendent's Office TO: CLERK OF D-PE W9) FIECEIVED FROM: gvtiffie Thompson JUL 18 2017 SUBJECT: Affidavits MARICOPA COUNTY DATE: 7/18/2017 CLERK BOARD OF SUPERVISORS Trease find attached 2 Afficravit/Xotice of Craim(s)for Cost warrants for indusion on the next avaiCabCe Ooard agenda The attached item(s) have been researched to ensure that the warrant(s) in question have not been cashed or previously re-issued The original-warrant(s), have had a stop payment crone. If you have any questions, please contact Marie Thompson at 372-1244 or via e-mail at mthompson@mcesa.maricopa.gov, 'Approved Affidavits may be routed back, to the Superintendent of School finance (ivision at 4041 N. Central - Avenue #1200, ( 12 th 'Floor) Thankyou. #59 LAVEEW RE wacycEL C0514PANY $191.43 #59 LAVEEN" SALT RIVEW, -MMECT $400.00 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: g 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. R.E. Michel Company (1), being first sworn, upon oath deposes and says: Name/Claimant On or about May 25, 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/c ssued to him/her in the sum of One hundred ninety one and 43/100 . (3) SigneW `>c 1/2. X • (4) Li Note: Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. (5) Subscribed abd-sworn to before me this day of 20/ 7. C NOTA PUBLIC Jean Pazdan Notary Public My corrynissi n expires: Baltimore County o 9 My Commission Expires October24,2019 (seal) Warrant/Check Number 470102329 (if known) (6) Original Date of Issue May 25, 2017 (if known) (7) Reason for original issue of Warrant/Check (8): O Payroll it For Services or Goods furnished ---AIAS44QPA-G€14:144TY--- ERK BOARD ciF SUP—ERc/TSORS O Treasurer's refund/payment 0 Other: S:\PROCESSES\Wrrants - Duplicate or Stale\02 Forms \Warrants Checks notice of claim - Copy.doc Revised April 2015 A.R.S. 11-632 & 11-644 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for gi 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, Salt River Project (1), being first sworn, upon oath deposes and says: Name/Claimant On or about August 11, 2016 (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 $ 400.00 .( 3) Signed: (4) Note: Please a6-C6 a copy of the warrant/check if available and/or any other evidence that a warrant/cheek was originally issued, (5) Subscribed and sworn to before me this ( day of to On. 20 t . e_o l et PO4H-ftth NOTARY PUBLIC PAMELA R-AFFIELD Nofafy Public - State of Nizona My commission expires: * My MARICOPA Cominteakm COUNTY Expires D er.incliottt ao 11? Novornbot. 20, 2010 seal) Warrant/Check Number 470011396 (if known) (6) Original Date of Issue August 11,2016 (if known) (7) Reason far original issue of Warrant/Check (8): 0 Payroll For Services or Goods furnished LI Treasurer's refund/payment 0 Other: SAPROCESSES\Warrants - Duplicate or Stale\02 ForrnS\Warrants Checks notice of claim - Copy.doc Revised April 2015 A.R.S. 11-632 & 11-644