072617 DUPLICATE WARRANTS 5.PDF

MCESA
Maricopa County Education Service Agency
INTEROFFICE MEMORANDUM
Maricopa County Education Service Agency
RECEIVED op
TO: Clerk of the Board 1,10
JUN 2 7 2017
FROM: CARRIE GUNDERSON
SUBJECT: Affidavits — Replacement of Lost /Stale Warrants CLERK MARICOPA BOARD OF COUNTY SUPERVISORS
DATE: 6/26/2017
PLEASE FIND ATTACHED AFFIDAVIT/NOTICE OF CLAIM(S) FOR LOST WARRANTS FOR
INCLUSION ON THE NEXT AVAILABLE BOARD AGENDA.
4 The attached item(s) have been researched to ensure that the warrant(s) in question have
not been cashed or previously re-issued.
q 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 garnishments(@.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
JOEL TUTNICK 170077174 Dated 5/31/17 for $1270.66
4041 N. Central Avenue, Ste. 1200, Phoenix AZ 85012 • 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: 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.
JOEL TUTNICK (1), being first sworn, upon oath deposes and says:
Name/CTaimant
On or about 6/1/17 (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 e i /her in the sum of $ 1,270.66 .(3)
Signed: (4)
fif attach a copy of the warrant/check if available and/or any other
77cdt 3 warrant/check was originally issued.
(5) Subscribed and sworn to before me this 2-6 day of 4/12E 2017.
)atitiFia 7: 04
'NOTXRY PUBLIC
DANUSIA T. COLE
My commission expires: Notary Public - MINS
Ain/ember cit ae0/9 My Comm. Martcops Expires county Nov 2, 2019 (seal)
Warrant/Check Number 170077174 —
(if known) (6)
Original Date of Issue
(if known) (7)
Reason for original issue of Warrant/Check (8): DAT
El For Services or Goods furnished
111 Treasurer's refund/payment
El Other:
5: \PROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc
Revised April 2015 A.R.S. 11-632 & 11-644

RECEIVED
INTEROFFICE MEMORANDUM JUN 2 8 2017
Waricopa County School-Superintendent's Office CLERK MARICOPA BOARD OF COUNTY SUPERVISORS
TO: CCM( OE VIE WA V.D
FROM: Thompson
SUBJECT: Affidavits
DATE: 6/27/2017
Pase find attached 1 Affidavit/Wotice of Cfaim(s)for Cost warrants for incrusion on
the next avaiCabre cBoardagendTa
The attached item(s) have been researched to ensure that the warrant(s) in
question have not been cashed or previousTy re-issued
The original warrant(s) have had a stop payment done.
If you have any questions, pfease contact 911illie 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 (Division at 4041 5\1: Central- _Avenue #1200, ( 12 th
ECoor) Thankyou.
#21 11VVVY .AVTO TETT ,710VSE $2039.27

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.
AUTO SAFETY HOUSE (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or aboutVY VAL / 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 be issued to him/her in the sum of $2,039.27 .(3 )
Signed: , 6/Vr7 (4)
(5) Subscribed and sworn to before me this 5 day of LrL.. 20)7 .
NOTARY PUBLIC
MARIA I. CASTILLO
My commission expires: NOTARY MARICOPA PUBLIC-State COUNTY of Arizona
kuti-L. -73 2_ 61- ? My Comm. Expires June 8,2018 (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 ArritU V r4 LP
47 0081977
(if known) (6) DAT ielfA f 11
Original Date of Issue 03/23/2017 /FY i — .401Ir .
(if known) (7) RKOAFb , OF SUFERVSCRS A - fi. I
MARICOPA COUNTY
Reason for original issue of Warrant/Check (8):
LI Payroll
II For Services or Goods furnished SUPPLIES/AUTO SAFETY HOUSE
LI Other: SUPPLIES/AUTO SAFETY HOUSE
Tr4EFT FROM . Po5-n4L -7-41A.Lk.
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