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INTEROFFICE MEMORANDUM Maricopa County Education Service Agency (aka Maricopa County Superintendent of Schools Office) TO: CLERK OF THE BOARD FROM: Denise Weihe SUBJECT: Affidavits — Replacement of Lost Warrants DATE: 3/21/2017 Please find attached 1 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, please contact Denise Weihe at 602-372-1245 or via e-mail at denise.weihe@mcesa.maricopa.gov . Approved Affidavits may be routed back to the Superintendent of School Finance Division at 4041 N. Central Avenue #1200, (12th Floor) Thank you. #68 Alhambra Practice Mix $768.31 REr,71vE'D MAR 2 i MAEICOPf Grq CLERK BOARD OF RECEIVED MAR 2 1\ 2017 WIARICOPA COUNTY CLERK BOARD OF SUPERVISORS 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. ) (1), being first sworn, upon oath deposes and says: Name/Cla mant On or about — 2LA (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 $ -1(o .(3) (4) (5) StAscilbed rn to before me this \-`‘ day of 2011. NOTARY CHRISTINA SAYEGH My cornmissiqn expires: Notary Pubilc - Arizona .-4)1 I11Dkq Maricopa County (seal) Expires OM 5/2019 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 O6Ce coL-e 1 . i Original Date of Issue Pfi° if known 7 - ZA --1 AK, MARICOPA B CON UTy Reason for original issue of Warrant/Check (8): 0 Payroll aTor Services or Goods furnished Tr44101c,e (37-1t 0 Other: S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of clalm.doc Revised June 2015 A.R.& 11-632 & 15-999 PracticeMa4, sr*. Smart Solutions. Maximum Results. CORPORATE OFFICE—SCOTTSDALE 9382 East Bahia Drive, Suite B 202 Scottsdale, Arizona 85260 P 480 374 7200 F 480 421 9899 March 13, 2017 This letter will serve as confirmation that I, Darren Wilson, affirm that Liana Udvardi is eligible to sign documents related to business between Alhambra Elementary School District and PracticeMax. Sincerely, Darren Wilson Director Private Pay & DSC PracticeMax.com