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INTEROFFICE MEMORANDUM 911aricopa County School-Superintendent's Office TO: CLERK OE Da (BOARD FROM: gfrtillie Thompson SUBJECT: Affidavits DATE: 3/14/2017 Pase find attached 2 AffidavitOotice of Craim(s)for Cost warrants for incrusion on the ne. -t avaifaôCe Ooard agenda The attached item(s) have 6een researched to ensure that the warrant(s) in question have not 6een cashed or previousey re-issued The original-warrant(s) have had a stop payment done. If you have any questions, pase contact Willie 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 W: Central-)venue #1200, ( 12 th 'Floor) Thankyou. # YIIGLET IVANA RVIZ $367. 69 #WIGL ET RO(BERT EATETTE $535. 79 RECEIVED MAR I 5201? CLERK MARICOPA BOARD OF COUNTY SUPERVISORS 0 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. IVAN A RUIZ (1), being first sworn, upon oath deposes and says: !'ihr7777AC;1C7'7ir""'t. On or about 3 / 0 *7 // 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. isstieOte,him/her in the sum of $ 367 . 69 .(3) Signed: (4) (5) Subscribed and sworn to before me this r day of Lk 20 ; . NOTARY PUBLIC OFFICIAL SEAL LEAH CRUZ j gm " Notary Public - State olArizona My commission expires: MARICOPA COUNTY 1 ,C1 I My Comm. Expires Oct 28, 2919 ! (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 170049984/60501301 (if known) (6) Original Date of Issue 02/16/2017 (if known) (7) Reason for original issue of Warrant/Check (8): Payroll Ci For Services or Goods furnished TTTERI'. Oi flESUPERVICS _ El 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 4ca,d 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. ROBERT LAFAYETTE (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 3 /08 /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 warrant/check be issued-to him/her in the sum of $ 535 .79 43) Signed: (4) (5) SubsFribied and sworn to before me this day of Ap.r,: 20 1 -1 . NOTARY PUBLIC OFFICIAL SEAL ,r‘r1114-1;91 LEAH CRUZ I My commission expires: Notary Public - State of Arizona IVIARICOPA COUNTY 1 (0 - (,)6 • ICI • ms.• • m.• Nly • ..m.• Comm. • ow. • woo Expires • • II• or • woo Oct • • 26, • 2019 (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 ?/60502925 // 7005- q (if known) (6) Original Date of Issue 03/02/2017 - L (if known) (7) Reason for original issue of Warrant/Check (8): Payroll Or'sr ERIC BOARD OF SUPERVISOR* 0 For Services or Goods furnished MARICOPA COUNTY 0 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