062117 DUPLICATE WARRANT - 1.PDF

INTEROFFICE MEMORANDUM
RECEIVED -
911aricopa County School-Superintenden•'s Office.
MAY 25 2017
TO: CLERX0E TOE 004R9)
MARICOPA COUNTY
FROM: 5frtillie Thompson CLERK BOARD OF SUPERVISORS
SUBJECT: Affidavits
DATE: 5/23/2017
TThase find attached 3 AffidavitOotice of Craim(s)for Cost warrants for incrusion on
the next avaifabCe Ooard agenda
The attached item(s) have heen researched to ensure that the warrant(s) in
question have not been cashed or previousCy re-issued
The original-warrant(s) have had a stop payment done.
If you have any questions, AdVe -oitiatt Millie Thompson at 372-1244 or via e-mad at
mthompson@mcesa.maricopa.gov. 'Approved J4fficfavits may he routed 6ack to the
Superintendent of School . 'Finance Division at 4041 X. Central. Avenue #1200, ( 12 th
Efoor) Thankyou.
#60 HIGLET . GILLESPIE ,S7fIELDS OVWX $250.00
#21 511VM-PY DA,XIEL 51/10WM -TE $529.53
#21gITURP-IfY (11.X./4 SWEAWLYGEN - $1201.57

Schools Affidavit/Claim Form CLERK, BOARD OF SUPERVISORS
MARICOPA COUNTY
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.
Gillespie Shields Durran (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 0 / 6,210101 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 $ 250.00 .(3)
Signed: (4)
(5) Subscribed and sworn to before me this -,(i)G, day of 20
NOTARY PUIEILIC
SELENA HINTON
My commission expires: ) Notary Public - Arizona
Maricopa County
1 My Comm. Expires Sep 14, 2018 (seal)
Note: Please attach a copy of the wan-ant/check if available and/or any other
evidence that a warrant/check was originally issued,
Warrant/Check Number 470081357
if known 6
Original Date of Issue 3/21/2017
if known 7
Reason for original issue of Warrant/Check (8):
0 Payroll
For Services or Goods furnished 10-1 t)/ /) d -for e dri)/ C
111 Other:
S:\PROCESSES\Warrants - Duplicate or Stale \02 Forms\Schools\Schools-Warrants Checks notice of daim.doc
Revised June 2015 A.R.S. 11-632 & 15-999

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.
Daniel Monette (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about ( (' -1-hob.CA/- --7-01 70/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 $529 .53 .(3)
(4)
(5) Subs sworn to befor this / 7.*1/4. day of 20 / 7.
TARY PUBLIC ry•Vf • I NY
OPRarAria"""""
My missiop expires: NOrpurA GRACIA i )
Z—At_hevi_ cRed MARICU i (seal)
k. '41W My Comr i, taCteOTNiz°na aoad " • -
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 170024020
(if known) (6)
Original Date of Issue October 20, 2016
(if known) (7)
Reason for original issue of Warrant/Check (8):
• Payroll
LII For Services or Goods furnished
El 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

JUN 02 DV
Schools Affidavit/Claim Form „A
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.
Tina Swearingen (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about Apri 1 30, 201 -Y- (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 he icciieri tn him/her in the ciim of ,1 1 ,201.57 .(3)
Signed (4)
(5) Subssrted and sworn to before me this / 7 day of L0-4, 20 / 7.
OFFICIALSEAL
BARBARA GRACIA j
mm)ssiory expires: — Notary Public - State of Arizona
/4 c3e)/6) My IVIARICOPA Comm. Expires COUNTY Sept 16, 20181 I (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 170063948
(if known) (6)
Original Date of Issue April 20, 2017
(if known) (7)
Reason for original issue of Warrant/Check (8):
• Payroll
El For Services or Goods furnished
El 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