062117 DUPLICATE WARRANT - 4.PDF

INTEROFFICE MEMORANDUM
I•I
Waricopa County School Superinteiufent's Office
01081AI:061S JO 013\109)03-13
TO: CLERK OE TOE (BOARD AiNnoo vdoolumtg
FROM: Iliffie 'Thompson LlOZ o Nnr ofo
SUBJECT: Affidavits
CI3A13031:1
DATE: 6/2/2017
Pci.se find attached 10 Affidavit/Notice of Craim(s)for Cost warrants for incrusion on
the ne.Kt avairaffe Ooard agenda
The attached item(s) have been 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, pThase'onfact Willie 'Thompson at 372-1244 or via e-mail - at
mthompson@mcesa.maricopa.gov , `Approved I4fficlavits may 6e routed back to the
Superintendent of School - finance Division at 4041 X Central- Avenue #1200, ( 12 th
Coor) Thankyou.
#201 OVC`KETE VNION W4 - 5\rVY OLAND $52.39
#5 ISAAC WAWA EL IZ/WE2 -1-f TORRES $536.68 cs., 529.29
WAWA ELIZA (BETif TORRES (7) 529.29 = 3705.03

dio\
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.
Randy Bland (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about September 29, 2016 (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 $ 52.39 .(3)
Signed: (4)
fore W21 .a..,___?1_,day c7 of ma rail 20 1 7
BEVERLY J. JOHNSON
Notary Public - Afizona
Maricopa County
My Comm. Expires Jul 24, 201t. (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 470026992
Of known) (6)
Original Date of Issue 09/29/2016
(If known) (7)
Reason for original issue of Warrant/Check (8):
D Payroll
I* For Services or Goods furnished reimbursement
Other: reimbursement
S:\PR0055ES\Werrant - Duplicate or Stale \02 Forms\Sthools\Schools-Warrants Checks notice of claim.doc
Revised June 2015 A.R.S. 11-632 & 15-999