062117 DUPLICATE WARRANT - 6.PDF

INTEROFFICE MEMORANDUM
Waricopa County School -Superintendent's Office
RECEIVED
TO: CLERK OF WE 0)1 CIO)
JUN 0 8 2.017
FROM: %lilac Thompson
SUBJECT: Affidavits MARICOPA BOARD OF COUNTY SUPERVISORS
CLERK
DATE: 6/8/2017
Please find attached 2 Affidavit/Arotice of Claim(s)for Cost 'warrants for inclusion on
the ne4 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 had a stop payment done.
If you have any questions, please contact Millie '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 X. Central Avenue #1200, ( 12 th
(Floor) Thankyou.
#59 LAvEziv - yriuns scifooL SOLVTIOXS $935.28
#59 LAVEEN SARA LEAVY $957.29

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: in Duplicate or 0 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.
Sara Leahy (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about August 5, 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 ahd owing, and the applicant requests that a replacement
warrant/chelc)be issued to him/her in the sum of $ 957 .29 .(3)
Signed: ih/ t (4)
Note; Please attach as.- cOpy of the warr t/check if available and/or any other
evidence that a warrant/Ohed:wa s originally issued.
(5) Subscribed and sworn to before me this / — day of 20 /
NOTARY PUBLIC
STEPHANIE MENUS
My commission expires: Notaly Public - State of Arizona
MARICOPA COUNTY
My Commission Expires (seal)
September 27,2020
Warrant/Check Number 170006835
(if known) (6
Original Date of Issue ust 5; 2016
(If known) (7)
Reason for original issue of Warrant/Check (8):
At' Payroll
El For Services or Goods furnished
ID Treasurer's refund/payment
D 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

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: • Duplicate or 0 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.
Harris School Solutions (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about November 17, 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 $ 935 .28 .( 3)
Signed: (4)
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
to before me this —'.° of i'"y
My commission expires:
14 /01
Warrant/Check Number 470042805
(if known) (6)
Original Date of Issue November 17, 2016
(if known) (7)
Reason for original issue of Warrant/Check (8):
CI Payroll
l• For Services or Goods furnished
CI Treasurer's refund/payment
CI Other:
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc
Revised April 2015 A.R.S. 11-632 & 11-644