072617 DUPLICATE WARRANTS 2.PDF

INTEROFFICE MEMORANDUM
llaricopa County School'Superintendent's Office
RECEIVED
TO: CLERK, 0 T DIE 0,/.4 WcI)
FROM: ,tilae (Thompson JUN 1 5 2017
SUBJECT: Affidavits MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS
DATE: 6/15/2017
Precise find attached 2 AffidavitOotice of Cfaim(s)for lost warrants for inclusion on
the neki available avrd agenda
sJ 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 warrantN have hada stop payment done.
If you have any questions, please contact Millie Thompson at 372-1244 or via e-mail at
mthompson@mcesa.maricopa.gov . :Approved Affidavits may be routed hack to the
Superintendent of School - finance (Division at 4041 N. Central -Avenue #1200, ( 12 th
Efoor) Thankyou.
#45 EOWL ER WI LYN - DANIELS $431. 5 2
#EOWLER EVELYN - gilrOWIZ $1080.93

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: El Duplicate 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.
MARI LYN DAN I ELS (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 $ 431.52 -( 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.
OFFICIAL SEAL
LAURA G. LOZOYA
Notary Public - Arizona
MARICOPA COUNTY
My Commission Expires
JANUARY 25, 2019
Warrant/Check Number 45226784
(if known) (6)
Original Date of Issue 06-02-2017
(if known) (7)
Reason for original issue of Warrant/Check (8):
Payroll APirn_rilvEn
O For Services or Goods furnished
O Treasurer's refund/payment
CI Other:
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc A.R.S. 11-632 & 11-6044
Revised April 2015

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: LI Duplicate or LI 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.
Evelyn Muniz (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 05-19-2017 (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, m. 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 $ 1080.93 .(3 )
Signed: A (4)
Note: Pie -se attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
20 /
BARBARA M. GILL
Notary Public - Arizona
My commission expires:
pt ? (seal)
Warrant/Check Number 45226125
(if known) (6)
Original Date of Issue 05-19-2017
(if known) (7)
Reason for original issue of Warrant/Check (8):
Payroll
El For Services or Goods furnished BOARDOF :11COPA SUPEPvISORS
El Treasurer's refund/payment
El 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