072617 DUPLICATE WARRANTS 4.PDF

INTEROFFICE MEMORANDUM RECEIVED V
Ilaricopa County Schoo(Superintendent's Office JUN 2 6 2017
TO: CLER( OE DIE 40 ')W9) MARICOPA BOARD OF COUNTY SUPERVISORS
CLERK
FROM: Iliffie Thompson
SUBJECT: Affidavits
DATE: 6/23/2017
Pase find attached 1 Affidavit/Wotice of Craim(s)for Cost warrants for incfusion on
the ne.v avadabfe oard agenda
The attached item(s) have been researched to ensure that the warrant(s) in
question have not been cashed or previousfy re-issued
.\1 The original- warrant(s) have had a stop payment done.
If you have any questions, pfeast contact Willie qfiompson at 372-1244 or via e-mad at
mthompson@mcesa.maricopa.gov . :Approved Affidavits may 6e routed back to the
Superintendent of School - Einan ,ce Division at 4041 11r. Centrar _Avenue #1200, ( 12 th
Efoor) Thankyou.
#60 .7-11GLET SA,NOM LETE $410.79

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.
SANDRA D LEPE (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about V - (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 $ 410.79 .(3)
Signed: (4)
(5) Subscril?ed and sworn to before me this d)-- day of T;A,4,---(2 2011 .
NOTARY PUBLIC OFFICKL. SEAL.
LEAH CRUZ
My commission expires: Notary Public - State of Mani
tO' 0(9• 1 01 My MikRICOPA Comm. Expires Oct. COUNTY 28, 201.9 I (seal)
..tesw• II• I ••I••••=0.11.11.1.0•11.11081f
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 lido 77586/60515214 p p
(if known) (6)
Original Date of Issue 06/08/2017
(if known) (7)
Reason for original issue of Warrant/Check (8): RBOARD ; ,...)A.F6S8.L7NE4 .SC,PtS
171 Payroll
LI For Services or Goods furnished
El Other:
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc A.R.S. 11-632 St 15-999
Revised June 2015

9v
RECEIVED
Maricopa County Education Service Agency
JUN 2 6 2017
—MARICOMZOUNIY
_CLERK BOARD OF SUPERVISORS
INTEROFFICE MEMORANDUM
Maricopa County Education Service Agency
TO: Clerk of the Board
FROM: CARRIE GUNDERSON
SUBJECT: Affidavits — Replacement of Lost /Stale Warrants
DATE: 6/22/2017
PLEASE FIND ATTACHED AFFIDAVIT/NOTICE OF CLAIM(S) FOR LOST WARRANTS FOR
INCLUSION ON THE NEXT AVAILABLE BOARD AGENDA.
A/ 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 done.
If you have any questions, please contact Carrie Gunderson at (602) 372-4833 opt.3 or via e-
mail at aarnishments@mcesa.maricopa.gov . Approved Affidavits may be routed back to the
Maricopa County Education Service Agency at 4041 N. Central Avenue #1200, (12th Floor)
Thank you.
Fund 781
ROSA RODRIGUEZ CHECK # 170079967 FOR $ 638.06
4041 N. Central Avenue, Ste. 1200, Phoenix AZ 8501 2 • Phone 602-506-3866 • Fax 602-506-
3753
www.maricopa.gov/mcesa Twitter: #mcesaaz Facebook: mcesaaz

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 irirr on this rrrrr correspond ArrirrAir on the
COUNTY OF MARICOPA .irtirrint Hir which is page 2 of this Cr.
Irr111111 (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 6/8/17 (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 hjm/her in the sum of $ 638.06 .(3)
Signed: (4)
Note: PleaWatta'ch a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
(5) Subscribed and sworn to before me this day of c/4.4t.C, 20 /7.
NOTARY PIIJBLIC
JOYCE C. COUNCIL
Notary Public- State of Arizona
My commission expires: MARICOPA COUNTY
My Commission Expires Sept 11,2017 (seal)
Warrant/Check Number 170079967
(if known) (6)
Original Date of Issue 6/8/17
(if known) (7)
Reason for original issue of Warrant/Check (8):
Payroll
111 For Services or Goods furnished
El Treasurer's refund/payment
LI Other:
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc A.R.S. 11-632 & 11-644
Revised April 2015

INTEROFFICE MEMORANDUM
Maricopa County Education Service Agency (aka
Maricopa County Superintendent of Schools Office) JUN 2 6 2017
MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS
TO: CLERK OF THE BOARD
FROM: Theresa Ysaguirre
SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 6/22/2017
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.
The original warrant(0iáVe h'ad a sidp payment done.
If you have any questions, please contact Theresa Ysaguirre at 602-372-1245 or via e-
mail at theresa.vsaguirre@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.
#65 Littleton Melissa Strand $235.43

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.
aa7 4 :s e 37; (1), being first sworn, upon oath deposes and says:
Nam
On or about /. ./ 020/ If) (date)(2) a warrant/check was issued to the
above named persdn/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 iss ed to him/her in,tbe sum of /$ Z35 A/3 .(3)
Signed: (4)
(5) Subscribed and swig n to before me this I ql day of 3 LO'\-e 20 .
J
NOTARY PUBLIC
cIAL SEAL
RAQUEL FLORES
My commission expires: Notary Commission Public • State #274462 of Arizona
Cit h \ 1 My comm. MARICOPA expires COUNTY March 1.2019 (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
(if known) (6) / 7000120 V
Original Date of Issue ,Z/
(if known) (7)
Reason for original issue of Warrant/Check (8):
CV-Payroll
K . BOARD OF SUHVIJUri6
0 For Services or Goods furnished
0 Other:
SAPROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc
Revised June 2015 A.R.S. 11-632 & 15-999