072617 DUPLICATE WARRANTS 9.PDF

INTEROFFICE MEMORANDUM,
Waricopa County School"Superintendent's Office
RECEIVED 0
TO: CLERK OE q9-E(B0A)
JUL 12 2017
FROM: Iliffie Thompson
MARICOPA COUNTY
SUBJECT: Affidavits CLERK BOARD OF SUPERVISORS
DATE: 7/11/2017
Please find attached 1 AfficfaviOrotice of Claim(s)for Cost 'warrants for inclusion on
the mkt available Woard agenda
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 bad a stop payment done.
If you have any questions, please contact Millie Thompson at 372-1244 or via e-mail at
mthompson@mcesamaricopa.gov . ApprovedAffidavits may be routed back to the
Superintendent of School - Einahce Division at 4041 X CentrarAvenue #1200, ( 12 th
ECoor) Thankyou.
#68 Af31:3110R3 (1091103VA 'LORES $49.35

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.
Ramona Flores (1), being first sworn, upon oath deposes and says:
Name/Claimant
n
On or about (') (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/chec)t)be issued to him/her in the sum of $ 49 .35 .(3)
Signed: ,AiZazd2,12rz (4)
6 me this 3i-c day of -3-LA I1 20 17.
OFFICIAL SEAL
CHERYL CARDER I
My commission expires: Notary PM* - Sate dAricona
MARICOPA COUNTY :
V17/DI My Comm. Expires Auo. 12 2017 1.1 (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) rl 'S (D% eti
Original Date of Issue 06/15/2017
(if known) (7) i A ri o/rnri. /
dr"Tr WS" ' ' .. 4
Reason for original issue of Warrant/Check (8): ERK, BO / ARD OF SUPERVISORS
IN Payroll MAR1COPA COUNTY
0 For Services or Goods furnished
0 Other:
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