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fl INTEROFFICE MEMORANDUM Z017 Waricopa County School-Superintendent's Office MARICOPA COUNTY CLERK BOARD OF SUPERVISORS TO: CLERK OE DfE 00AR9) FROM: Willie 'Thompson SUBJECT: Affidavits DATE: 4/28/2017 Pase find attached 3 Affidavit/Arotice of CCaim(s)for Cost warrants for incrusion on the next avaifabte Ooard agenda The attached item(s) have been researched to ensure that the warrant(s) in question have not been cashed or previou.dy re-issued The original-warrant(s) have had a stop payment done. If you have any questions, please contact Mille Thompson at 372-1244 or via e-mad 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 Eroor) Tfiankyou. #44 AVONDALE DESIREE KALLS $ 623.51 #66 ROOSEVELT josTro SWITif $1297.40 #216 AGO EWA KATRIA OSALES $1079.34 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. alirc`LM1/d (1), being first sworn, upon oath deposes and says: arne anent On or about Li - (e) - (PO n- (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 o him/her in the sum of $ (PP.3. 5 I .(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. (5) Subscrib0 and sworn to bpeore me this .!:7W1-1/clay of 20 /7 . Ni'TMPUBLIC OFFICIAL SEAL /C71-2‘ C LAURAN/ERA n expires: !:04 ?; Notary Public - State of Arizona 3//oZ2 /7 I 34 5' MARICOPA COUNTY (seal) Mv Gomm Expires Aug. 31, 2017 Warrant/Check Number IOD oI 55 1 (if known) (6) Original Date of Issue (if known) (7) Reason for original issue of Warrant/Check (8): Et. Payroll MARICOPA • COUNTY , , i 7 E'TVISORS D For Services or Goods furnished El Treasurer's refund/payment 0 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 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. /111ai..,..ntI/ cm. 0 S . 1A- 4 (1), being first sworn, upon oath deposes and says: tar0 On or about 03///0/7" (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 issOedp him/herp th9 .(3) Signed: r (4) Notary Public State of Arizona Maricopa County Ashley Ann Michel My Commission Expires 07/0312017 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 170056782 (if known) (6) Original Date of Issue 03/16/2017 (if known) (7) Al rf #17,49 Reason for original issue of Warrant/Check (8): MARICOPA L-C,AP.. c.) COUNTY sijaEi*, 0 For Services or Goods furnished CDZOther: T No' eetoy i ved 0 ii SAPROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc Revised June 2015 A.R.S. 11-632 8,L 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. ROSALES, KAYRIA .(1), being first sworn, upon oath deposes and says: Name/Claimant On or about 3/29/17 (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 -(3) Signed: (4) (5) Subscribe and sworn to before me this ,,)°/ 1->-- Y day of 20)7. NOTARY PUBLIC FINTMESlala.OSZNI NOTARY PUBLIC My commission expires: STATE Maricopa OF ARIZONA County KYLE ANDREW ANDERSON (seal) My Commission Expires April 20, 2020 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 170058331 11/- I7 1 (if known) (6) Original Date of Issue 3/23/2017 , (if known) (7) MAHIco uNy Reason for original issue of Warrant/Check (8): • Payroll 0 For Services or Goods furnished 0 Other: S:\PROCESSES\Warrants - Duplicate or Stale\02 Fonns\Schools\Schools-Warrants Checks notice of claim.doc Revised June 2015 A.R.S. 11-632 & 15-999