072617 DUPLICATE WARRANTS 1.PDF

INTEROFFICE MEMORANDUM
11 -!ECEIVED
Waricopa County Schoo(Superintendent's Office
JUN 1 5 2017
TO: CLERX OE WE Wq)
MARICOPA COUNTY
FROM: Thompson CLERK BOARD OF SUPERVISORS
SUBJECT: Affidavits
DATE: 6/14/2017
Pase find attached 4 Affidavit/Arotice of Craim(s)for Cost warrants for inclusion on
the next avaifabCe cBoarciagencia
The attached item(s) have been researched to ensure that the warrant(s) in
question have not been cashed or previousfy re-issued
The original-warrant(s) have had a stop payment done.
If you have any questions, prease contact Millie Thompson at 372-1244 or via e-mad at
mthompson@mcesa.maficopa.gov . Approved Affidavits may be routed back to the
Superintendent of School - Einance Division at 4041 X. Central- Avenue #1200, ( 12 th
ECoor) Thankyou.
#31 OALSZ NEXT LEVEL .914AINTEWANCE SOLVTIONS $3316.00
#45 EOWLER WAWA DE LA ROSA $445.98
#60 Y -CI LET N-GEL E1/1200(DSOX 181.56
#95 VEEN - CREEK " OLLIE AWC.71A5140ArULT AZ READINg ASSOC
$248.00

AFFIDAVIT
STATE OF ARIZONA
COUNTY OF MARICOPA
")<1— LLA E L
(Thq( 'T e--1\ r'') C _C-)t, LuTfctkiS, being first duly sworn, upon oath deposes and says:
(Name and Title of Person)
That on 15 /f9t2 tL , 20 I 1, he/she presented to -8 c)1--SZ. CgC4 -1(ThOL /ST. .31 of
(School District Name)
Maricopa County, Arizona, for payment, a claim for services rendered or supplies furnished during the
month of tq ,20 11 , said claim being in the sum of ($3,3l (p. OiO )
ize€, —11-16Lispik) 4-114 F.Ola,g__-0 St KT e&AJOYekpollars in payment of which
the Superintendent of Schools caused his/her Warrant Number "\if 10 0 94,A.Cp0 to be issued
on q 1\.firct. , 20 I -7, drawn on the 0C4 Fund of Et.,sz Sck66g_ 2)/3-7..ozi of
(School District Name)
Maricopa County, Arizona.
Affiant further says that although he/she was informed and believes that the above mentioned warrant
was regularly issued, the same has never been received, or has been lost.
WHEREFORE, affiant prays that the Board of Supervisors order and the Superintendent of Schools issue
to him/her a duplicate of said Warrant Number V '260 94, "-Co C) in the sum of $ 3 , 3O .
Signed: Est-1 -VO 0 \(e /C)-ai kte
Mame and Title of Authorized Personnel)
Subscribed and sworn to before me this 5 day of Sli&t,
NOTARY PUBLIC: r,
My commission expires: Ni (f5111/ „1-0
Following approval please return this affidavit to the Maricopa County Education Service Agency Office.

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: 4Duplicate or El 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.
MARIA DE LA ROSA (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 06-02-2017 (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 be issued to him/her in the sum of $ 445.98 .(3 )
Sind : (4)
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
and sworn to before me this day of 20/7
OFFICIAL SEAL
LAURA G. LOZOYA
My commission expires: Notary MARICOPA Public COUNTY - Arizona
My Commission Expires (seal)
JANUARY 25, 2019
Warrant/Check Number 45226548 / go o
(if known) (6)
Original Date of Issue 06-02-2017
(if known) (7)
Reason for original issue of Warrant/Check (8):
Payroll
El For Services or Goods furnished
• Treasurer's refund/payment
O 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

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.
Angele Woodson (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about Oc___5 05 (date)(2) a warrant/check was issued to the
above named persofi/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 )7 to him/her in the sum of $ / .6 /p .(3)
I r, )
Signed: A ' ------' (4)
(5) Subscribed and sworn to before me this Dq' day of 20 ; .
NOTARY PUBLIC OFFICIAL SEAL
LEAH CRUZ
Notary Public -State of Arizona
My commission expires: MARICOPA COUNTY
1C1 M y Comm. Expires Oct. 26, 2019 lj (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 470095044
(if known) (6)
Original Date of Issue 05/05/17
(if known) (7) 2 LPfli, koi---/
Reason for original issue of Warrant/Check (8):
LI Payroll
11-- For Services or Goods furnished Park
A Other: yr I f a_ Se.. te h - e
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.
011ie Archambault -AZ Reading Association (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about January 31,2017 (date)(2) a warrant/cheek was issued to the
above named person/entity in the amount as stated below. Such warrant/cheek 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 $ 248.00 43)
Signed: OA; (4)
(5) Subscribed and sworn to before me this I q+14 day of)A 20 1 1
I I\ f\ C\
Tt)
OFFICIAL SEAL
MARGARET TEJADA
My commission expires: NOTARY PUBLIC - State of Arizona
daelMt31720t7 My Comm. FINAL Expires COUNTY December 18,2017 (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 47-0066627
(if known) (6)
Original Date of Issue 1/31/17
(if known) (7) A
Reason for original issue of Warrant/Cheek (8):
O Payroll
IR For Services or Goods furnished
o Other:
SAPROCESSES\Warrants - Duplicate or Staie\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc
Revised June 2015 A.R.& 11-632 & 15-999
(2, 4