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RECEIVED Waricopa County School' Superintendent's Office MAY 0 5 2017 TO: CLERX OE DrE 00AW(j) MARICOPA COUNTY CLERK BOARD OF SUPERVISORS FROM: ,tiffie Thompson SUBJECT: Affidavits DATE: 5/4/2017 Pfease find attached ,i''AffidavitOotice of Claim(s)for Cost warrants for inclusion on the mkt available oard 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 originaCwarrant(s) have had a stop payment done. If you have any questions, Afa:W6ntaCt 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 Einarice (Division at 4041 N: Central-Avenue #1200, ( 12 th Efoor) Thankyou. #5 ISAAC Az 7C-13 CE.ArTER $150.00 # ALIIAMOM CASSIE WOORIGVEZ $322.16 a $187.42 Ats Affritlavit/Claim Form Application for a Duplicate War 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. 1:14-7Q—l (1), being first sworn, upon oath deposes and says: ame anan --- On or about 1C(Ctelfign(date)(2) a warrant/check was issued to the above named person/entity n 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 $ ISa 00 .(3) Signed: (4) (5) 20 0 TIMOTHY .1. METZ it4a7 Stab3 alkizona MAR1COPA COUNTY My Commitalan ExiSru (seal) Dectmber 7, 2018 Mote: 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 MA' 08 (if known) (6) 41- 00(o Of DAT; Original Date of Issue ., v. (if known) (7) i—lq—gOri MARCOPA Reason for original issue of Warrant/Check (8): El Payroll r Goods furnished beCerYlbel —q o t (ft El Other: ROCESEESVCrr7.rits - Lupkate or StEle' 02 Fcn:\Sc!*.c 15' d 1,,.-V..:rrsnts Check: r-ct.ce cf clairo.oc Ri 3vne. 2015 A,R,S. 11-532 a 15-S99 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. e_ Vcic - 2 (1), being first sworn, upon oath deposes and says: Name/Claimant On or about (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 $, cz51 LA .(3) Signed: (4) (5) Subscribedrand-swor, o before rpfir thiqi day of M6t-(4. 20 / 7. NOTARY P LIC OFFICIAL SEAL My_ commission expires: Notary HEATHER Public-State L. ofArizona LUSK i I1ACtj I S d-02:0 MARICOPA COUNTY 1 (seal) ; 'stark/ My Comm. Expires May 15,2020 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 cf-i " (z)6c71 f MA 08 17 Original Date of Issue r)- Zb-- 1-1 (if known) (7) Reason for original issue of Warrant/Check (8): LII Payroll LI For Services or Goods furnished Ir-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. c v..0a (1), being first sworn, upon oath deposes and says: Name/Claimant On or about /2/ Y-1 (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 tp, him/her in the sum of $ ,)Q-(3 (3) Signed: (4) ci- (5) Subscribed and sw, to before day of 20 1 Are. , A _ NOTARY-PUBLIC r1;2 OFFICIAL SEAL ! My commission expires: Notary HEATHER Public - State L. LUSK ofArizona I/ in 15 i ,140.Z.0 MARICOPA COUNTY (seal) My Comm. Expires May 15, 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 M - 08 2017 (if known) (6) Original Date of Issue ' i (if known) (7) — Z-17 Reason for original issue of Warrant/Check (8): LI Payroll El For Services or Goods furnished ErOther: 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. /Mai aaki4C7 (1), being first sworn, upon oath deposes and says: Name/Claiman On or about cm/ye 3(7, aot (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/hyr in the sum of $ 6//0 .(3) (4) (5) Sub'svibed and sworp,to before) e this day of 20/7. JEANETTE R. SIMMONS NOTARY PUBLIC ) Notary Public - Arizona Maricopa County 1\.'19' commission exp ires: My Comm. Expires Jan 31, 2018 ,M(d-44:7 al) tz 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 /0 , .— 6-L) . 1 707 Y OR 2 17 (if known) (6) Original Date of Issue 67 0/' Ol' , (if known) (7) . _ Reasonjor original issue of Warrant/Check (8): "CLERK. MARICOPA CCU Payroll 0 For Services or Goods furni,shed 0 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 51'46(41 .