072617 DUPLICATE WARRANTS 7.PDF

INTEROFFICE MEMORANDUM
Maricopa County Education Service Agency (aka RE
Maricopa County Superintendent of Schools Office) JUL 0 3 Z017
COUNrt
CLERK WIARICOPA BOARD OP SUPERVISORS
TO: CLERK OF THE BOARD
FROM: Terri Ysaguirre
SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 6/29/2017
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.
V The original warrant(s) have had a stop payment done.
If you have any questions, please contact Terri Ysaguirre at 602-372-1245 or via e-mail
at theresa.ysaguirre@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.
#90 Saddle Mountain $48.96
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11:46:50 a.m. 06-20-2017 3 9375343497
9375343497 Synchrony Financial 14:44:41 06-20-2017 3/3
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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 farm.
•
amerulauna first sworn, upon oath deposes and says:
On or about t)-14-"Cin a:3 Q0i,71 (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 $ ipsco .(3)
Signed: 41/ 1-e- "1 (4)
(5) SubscrifIRed and sworn to before me this day of 3ti-ft-g 20 II
Ar2_ 9_0 (
I NOTARY P11.1131.1C 0
Lisa Men
my Notary Public
comalis§rj_exprz State of Ohio
My Commission Expires
April 4. 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
APP
Warrant/Check Number '
(If known) (6) 90S5dif49/5 4-1700g/,,53
Original Date of Issue
(If known) (7) QS , Qc>11 CLERK. IOARD OF SUPERVISORS
ARICOPA COUNTY
Reason for original issue of Warrant/Check (B):
0 Payroll
54or Services or Goods furnishe
0 Other:
S:\PRocESsES)Warrants- Revised June 2015 Duplicate or 5(3102 FormA5choots15thools-Warr2nts Checks notice of daindoc
A.RS, 11-632 6.15-999