041217 DUPLICATE WARRANTS 8_REDACTED.PDF

Maricopa County
Human Resources
Memo —4
—4—
To: Fran McCarroll, Clerk of the Board
From: Wanda Childers
Date: March 30, 2017
Re: Replacement of Lost Payroll Warrants
Please find attached I Affidavit/Notice of Claim(s) for lost
payroll warrants for inclusion on the next available Board 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 original warrant(s) have had a stop payment done.
Please call Wanda at ext. 60409 for any questions. Please route
approved Affidavits back to County Payroll, Suite 220.
Stale Dated Warrant Duplicate arrant
Thank you.
Replacement Lost Warrant Form 1 02/25/2015

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: M 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. - -:o
Nicole Rees ), being first sworn, upon oath deposes and says:
Name/Claimant --0
On or about 03/22/2017 (date)(2) a warrant/check was issued to
above named person/entity in the amount as stated below. Such warrant/check sas
either never received or was subsequently inadvertently lost or destroyed ancrthere - 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/che*I4e-l-ssued to him/her in the sum of $ 877.26 .(3)
Signed: (CY- (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) Subscribed and sworn to before me this „21)-1-1-\ day of kat r 20 /7.
NOTARY PUBLIC
My commission expires:
Warrant/Check Number
(if known) (6) 44 17/ 7,V.Y
Original Date of Issue
(if known) (7)
Reaso9,for original issue of Warrant/Check (8): ni7
Vi Payroll
LI For Services or Goods furnished GU N
LI Treasurer's refund/payment
LI Other:
Revised April 2015 A.R.S. 11-632 & 11-644

INTEROFFICE MEMORANDUM
Ilaricopa County School-Superintendent's Office
TO: CLERK OE 79PE 00AW9)
FROM: Mcrie (Thompson
SUBJECT: Affidavits
DATE: 3/29/201 7
Prease find attached 4Affidavit/Xotice of Cfaim(s)for Cost warrants for incrusion on
the ne.)ct avaifaBCe Board agenda
The attached item(s) have been researched to ensure that the warrant(s) in
question have not been cashed or previous Cy re-issued
The original- warrant(s) have had a stop payment done.
If you have any questions, prease contact Willie Thompson at 372-1244 or via 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
Efoor) Thankyou.
#214 TOLLESON . 'UNION-AS VNIVEWSITY OF XEW7-1 -AMPS1C1RE $675.00
#214 TOLLESON - VNION KVIA SOPTWARE $1301.00
#75 MORRISTOWN - XAPA AVTO PARTS (2) $8.91 Ci 31.53
RECEIVE
MAR 2 9 2017
MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS
NtnJ t QC

'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.
Kuta Software (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about January 1, 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 $ 1,301.00 .(3 )
Signed: (4)
(5) Subscribed and sworn to before me this 22 day of co_C s 2O V .
I W i ll
YY/.1,73& %0,14' 141CH04,4%
..1,6.1.1;; SV647 ... °#,
NOTARY PUBLIC
2 t•X 0 TA Rktt .1)
•2 co 13 -
My commission expires: I % PUBLIC • :
ititc.t o c t,‘ 2020 .1P-22-20P.•:$ (seal)
.•
"toll to'
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 214735827/470062474
(if known) (6)
Original Date of Issue 1/1 7/1 7
(if known) (7)
Reason for original issue of Warrant/Check (8):
D Payroll
*I] For Services or Goods furnished Invoice 14250 for purchase order 1703150
111 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

KUTA Kuta Software LLC Change of Address Notice
14 6308 Holland Meadow Lane
Software Gaithersburg, MD 20882-1236
Phone: (877) 563-2285 Fax: (866) 740-7994 orders@kutasoftware.com
Tolleson Union High School District #214
Attn: Accounts Payable
9801 West Van Buren Street
Tolleson, AZ 85353
The address for Kuta Software LLC changed in spring 2010 to the following:
Kuta Software LLC
6308 Holland Meadow Lane
Gaithersburg, MD 20882-1236
Please update your records so that you use this address for all correspondence including orders
and payments. Items sent to our old address may be returned or lost. A W-9 form with our
updated address is attached.
Thank you,
Michael Kuta
Managing Member
Kuta Software LLC

SCHOOL EXPENSE WARRANT JPMorgan Chase Bank, N.A. 470062474
Phoenix. AZ
TREASURER OF MARICOPA COUNTY
PHOENIX, ARIZONA 91-2/1221 DATE I CONTROL NO.
THIS INTEREST WARRANT STOPS DRAWS ON DATE INTEREST FUNDS FROM AVAILABLE DATE (SEC MARKED 11-636. INSUFFICIENT ARS1956) FUNDS' 01/1712017 I 214735827
It V Tolleson Union High School District #214
WARRANT AMOUNT
'ACYne Thousand Three Hundred One and 00/100*" Dollars $1,301.00
VOID AFTER 365 DAYS
Kuta Software LLC I••••••I••••••
0 5765 Selfridge St.
HE
RDER Buzzards Bay, MA 02542 sul=gen't'70 .t83%
AUTHORIZED SIGNATURES
via 700P, 2 11.07411° 22 ,000 2 11-01g 704 3949 311°
01/17/2017 Check: 214735827 EXPENSE
iARICOPA COUNTY SCHOOLS PHOENIX, ARIZONA AP Run Date 01-18-17 470062474
Kuta Software LLC 01/17/2017
Payee Check Date
--- Account Number PO Number Invoice Amount
61010010CC68435160000000 1703150 142E0 1,301.00
P 11)
JAN! 8 201?
VOUCHER: 9107 TOTAL: S1.301 00
HARLAND CLARKE M22692 60126026

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.
Unveristy of New Hampshire (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about December 1, 2016 (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 is ued to him/her in the sum of $ 675.00 .(3)
Signed: Id, ) AL (4)
(5) Subscribed and sworn to before me this day of &kali 20/'
y commission expires:
Ai .21 - (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 214734599/470046756
(if known) (6)
Original Date of Issue 12/1/16 T MA 1 2017
(if known) (7) -
Reason for original issue of Warrant/Check (8): LERK BOAFiD OF COUNTY SUPERVISORS
111 Payroll MARICOPA
gl For Services or Goods furnished Professional Development
LI 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

Institute on Disability/UCED
A University Center for Excellence in
Disability
10 West Edge Drive
Suite 101
Durham, NH 03824-3513
V: 603.862.4320
F: 603.862.0555
TTY: 711 (Relay NH)
March 22, 2017
iod.unh.edu
Beth Udisky, District Prevention Coordinator
Tolleson Union High School
9801 W. Van Buren
Tolleson AZ 85353
Subject: Missing check #214734599
Hello,
I am a Business Manager at the Institute on Disability at UNH. We have not received check
#214734599, dated 12/1/16 in the amount of $675, for our invoice #5237.
Thank you,
Jill Varney
Business Manager
Institute on Disability
10 West Edge Drive Suite 101
Durham NH 03824
T: 603-862-3476
F: 603-862-0555
Jill.varneyPunh.edu
www.iod.unh.edu

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: 0 Duplicate or 0 Stale-Dated (definitions are on page 2)
STATE OF ARIZONA Note: Numbers on this (orrn correspond to numbers on the
COUNTY OF MARICOPA Instruction sheet which Is page 2 of this form.
/)14de fi lq;v4S (1), being first sworn, upon oath deposes and says:
am Daimon
11„
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 prob f its being found or presented for payment, Qr it was not
presented for pa ent wit n one year after the date of issuance.
Therefore, under pen of perjury, laimant hereby affirms that this claim is correct
and the amount sh n is due and ing, and the applicant requests that a replacement
warrant/check/11e issued to /her in the sum of $ .(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) Subscri ed and sworn to before roe this p4i4i_day of 20 1*--).
0.0 00,11$110/01
%LAI °,
NOTARY PUBLIC ,c4Ot ark 10.01,471Z; •G
0 i ...
My commission expires: pubV, / 41.x.4.:==1 .1,...it, ( ;.... _
Warrant/Check Number 1176) 0-77,2''''? - rat 5 "..:Pii'—wci;."--r.,, 109, co un.1 + 0 , -,,-
(if known) (6) littlift0
Original Date of Issue 04.1±-±ZW
(if known) (7) /
Reason for original issue of Warrant/Check (8): APPPOVED
O Payroll M Al 31 2j
DAT
126; Services or Goods furnished
„.7A,51 .•
O Treasurer's refund/payment BOAFID OF SUPERVISORS
MARICOPA COUNTY
O Other:
Si \PROCE.SSES\Warrants - Duplicate or Stale \02 Forms\Warrants Checks notice of claim Copy.dec
Revised April 2015 A.R.S. 11-632 & 11-64A

Sharon Beaucham
From: GPC IT Service Desk <gpc@service-now.com >
Sent: Tuesday, March 28, 2017 7:57 AM
To: sbeauchamp@morristowneld75.org
Subject: INC2941450 - lost of check from county
Attachments: Morristown School Districe 75.pdf
Good morning Sharon,
Please find attached the completed forms sent for the payments we did not receive for your invoices 973385
$8.91 and 975642 $31,53.
These forms were signed by Roxeann Ruiz, Solutions Center Supervisor
Roxeann Ruiz
Solutions Center Supervisor
GPC AFAR Shared Services
Phone: 877-558-9287 Fax: 404-924-3888
Ref:MSG24063640
1