062117 STALE DATED WARRANTS - 1 REDACTED.PDF

INTEROFFICE MEMORANDUM
Maricopa County School Superintendent ‘s Office
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TO: CLERK OF THE BOARD SuOSIAA TY YsOOIEMIN
FROM: Millie Thompson NTA ae
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SUBJECT: Affidavits
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DATE: 6/2/2017
Please find attached 10 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, pledse'Lontact 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 N. Central Avenue #1200, (12 th
Floor) Thank you.
#201 BUCKEYE UNION. RANDY BLAND $52.39
#5 ISAAC MARIA ELIZABETH TORRES $536.68 529.29
MARIA ELIZABETH TORRES (7) 529.29 = 3705.03

‘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.
MARA Elizaséra TOkRES (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about AY BO oO |) (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 $ ee CI chad. ber (3)
Signed: Cae & asap (4)
(5) and sworn to before me this AO day of Adu 20 I")
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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)
Original Date of Issue
(if known) (7)
Reason for original issue of Warrant/Check (8):
O Payroll
C1 For Services or Goods furnished
1 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

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.
TORRES, MpkiA Elizaperé (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about MAY 30,2017 (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 § S3G-6f (3)
Signed: Warr EF > ao (4)
(5) Subscribed and sworn to before me this Zor day of May 20\7)_.
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NOTARY ste,
OFFICIAL SEAL h
My commission expires: Notary Pubic - vale
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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
& OOBY Qo X
(if known) (6) \
Original Date of Issue
<) MAS
(if known) (7)
Reason for original issue of Warrant/Check (8):
O Payroll
C1 For Services or Goods furnished
O 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

Schools Affidavit/Claim Form
Application for a Duplicate Warrant/Check (definitions are on page 2)
ARIZONA Note: Numbers on this form correspond to numbers on the
STATE OF
Instruction sheet which is page 2 of this form.
COUNTY OF MARICOPA
TORRES, MAaA Elizparsér__(1), being first sworn, upon oath deposes and says:
~~ Name/Claimant
(date)(2) a warrant/check was issued to the
On or about (MA/ 50,2017
above named person/entity in the amount as stated below. Such warrant/check was
received or was subsequently inadvertently lost or destroyed and there is
either never
reasonable probability of its being found or presented for payment, or it was not
no
presented for payment within one year after the date of issuance.
under penalty of perjury, claimant hereby affirms that this claim is correct
Therefore,
and the amount shown is due and owing, and the applicant requests that a replacement
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warrant/check be issued to him/her in the sum of $
Signed: _Wf{zaes ie ss (4)
Subscribed and sworn to before me this Bom day of Man, 20.171.
(5)
NOTARY PUBLIC ee tnesseeeeee s
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* 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 /6- . 6074 690
(if known) (6)
Original 3 Date of Issue 5/Ja/o0/e
(if known) (7)
original issue of Warrant/Check (8):
Rese
Payroll
O For Services or Goods furnished
O Other:
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc
A.R.S. 11-632 & 15-999
Revised June 2015

ISAAC SCHOOL DISTRICT NO. 5
3348 West McDowell Road
Phoenix, Arizona 85009-2416
602-455-6700 Fax 602-278-1693
Mario Ventura, Ed.D.
Superintendent
May 30, 2017
Attn: Millie Thompson - MCESAX
Dear Millie:
Our current employee Maria Elizabeth Torres presented several “stale dated” checks that she just recently found. She
stated that her Spouse forgot to deposit the checks when they were issued and asked if we were able to stop payment
and re-issue new ones. Listed below are the warrant numbers in question:
Warrant # Date Issued Amount Payable to:
160076922 4/28/2016 $529.29 Torres, Maria Elizabeth G
160074111 4/14/2016 $529.29 Torres, Maria Elizabeth G
160065171 3/03/2016 $529.29 Torres, Maria Elizabeth G
160069081 3/17/2016 $529.29 Torres, Maria Elizabeth G
160061909 2/18/2016 $529.29 Torres, Maria Elizabeth G
160055528 1/21/2016 $529.29 Torres, Maria Elizabeth G
160052178 1/07/2016 $529.29 Torres, Maria Elizabeth G
Please use the warrant information above as an attachment to the Stop Payment request and affidavit.
If you have any questions regarding the above information, please feel free to contact me.
Regards,
Olivia Castillon 4
Payroil Department