032217 DUPLICATE WARRANTS 1_REDACTED.PDF

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MARIC.CP.% C,01J7.!1'.? Maricopa County
2011 FEB 23 Fi'l 3: 14 Human Resources
Memo
To: Fran McCarroll, Clerk of the Board
From: Debbie Milliron
Date: February 28, 2017
Re: Replacement of Lost Payroll Warrants
Please find attached 1 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 Debbie M. at ext. 62406 for any questions. Please
route approved Affidavits back to County Payroll, Suite 220.
Stale Dated Warrant c Duplicate Warrant
Thank you.
Replacement Lost Warrant Form 1 02/25/2015

Application for a Duplicate or Stale-Dated Warrant/Check
Affidav[i[1:/Ciaihil Form
This application is for: uplicate or EJ 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.
Richard Dawson (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 2/22/2017 (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 e iss to him/her in the sum of $ 621.86 .(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) Subscribed and sworn to before me this 213 day of Vt,A0 20_11.
NOTARY PUBLIC
EILEEN WILLIAMS-PFTEAS
Notary Public - State of Arizona
My commission expires: MARICOPA COUNTY
1l.ok•Mig My November Commission 11, 2018 Expires (seal)
Warrant/Check Number
(if known) (6) t
Original Date of Issue
(if known) (7)
Reason for original issue of Warrant/Check (8):
Payroll
LI For Services or Goods furnished ATC 1_142-eri
El Treasurer's refund/payment /
"PI/ /1"
El Other:
Revised April 2015 A.R.S. 11-632 & 11-644

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: 2/28/2017
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.
#79 Litchfield Butterfly Wonderland $234.25

LJ- K;tt-ir-Ne
kvo; 'QL__447,5
n61563
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.
BUTTERFLY WONDERLAND (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 10/25/2016 (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 peiluiy, 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 $ 234.25 .(3)
Signed: ki1C—C-- 6V\ A (4)
(5) Subscribed and sworn to before me this `---1 day of 1-4D ,--`•0-1 201 . 1 .
fj RACHELLE STRICKMAN
-NOTARY-PUBUCTARIZONA-
NOTARY PUBLIC t:"Elj MARICOPA COUNTY
My Commission Expires
* 41141/ June 07, 2020
My commission expires:
10/25/2016 (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 470035114/79708841
(If known) (6) , -
Original Date of Issue 10/25/2016 I111111.• i
(if known) (7)
Reason for original issue of Warrant/Check (8): MAA;COPA COUNTY
LI Payroll
El For Services or Goods furnished FIELD TRIP ENTRANCE FEE
RI Other: FIELD TRIP ENTRANCE FEE
SAPROCESSES\Warrants - Duplicate or Stale \02 Forms\Schools\Schools-Warrants Checks notice of clairn.doc A.R.S. 11-632 & 15-999
Revised June 2015

Feb. 22,2017
BUTTERFLY
WO RLAN
Beverly Marstall
Accounts Payable
Litchfield Elementary School District #79
This letter is to confirm that Adriane Grimaldi is authorized by this company to sign the
affidavit.
Jeanette Scott
Accounting Manager
9500 E. Via de Ventura, Suite F100, Scottsdale, AZ 85256
(480) 800-3000
www.butterflywonderland.com

ICESA,
Maricopa County Education Service Agency
INTEROFFICE MEMORANDUM
Maricopa County Education Service Agency
TO: Clerk of the Board
FROM: CARRIE GUNDERSON
SUBJECT: Affidavits — Replacement of Lost /Stale Warrants
DATE: 2/28/2017
PLEASE FIND ATTACHED AFFIDAVIT/NOTICE OF CLAIM(S) FOR LOST 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.
-4 The original warrant(s) have had a stop payment done.
If you have any questions, please contact Carrie Gunderson at (602) 372-4833 opt.3 or via e-
mail at garnishments@mcesa.maricopa.gov . Approved Affidavits may be routed back to the
Maricopa County Education Service Agency at 4041 N. Central Avenue #1200, (12th Floor)
Thank you.
Fund 781
GREATER GLENDALE FINANCE 17004442 Dated 1/11/17 for $80.68
4041 N. Central Avenue, Ste. 1200, Phoenix AZ 85012 • Phone 602-506-3866 • Fax 602-506-
3753
www.maricopa.gov/mcesa Twitter: #mcesaaz Facebook: mcesaaz

APPROVED
DA P.Or7
AFFIDAVIT OF LOST, MISSING CHECK K, 8oApp—o-r-s-7
MARICOPA COUNTY
I, Robert Bartolini, being first duly sworn upon oath, depose and state the following :
1. A check (s) was issued by the Maricopa County Education Service Agency, which is
identified as follows:
Issuing County: Maricopa
Docket : CC2015-070841RC
CHECK NUMBER: ir T 0 0 441./ 42
is SUE DATE: /1)1//7
AMOUNT: $ 80.68
PAYABLE TO: Greater Glendale Finance
2. That the above-described check has not been received by me.
3. That the above-described check has been missing.
4. That by this affidavit I am requesting that the Maricopa County Education Service
Agency place a STOP PAYMENT on the above described check and to reissue a
replacement check. I further understand that under no circumstances should I present the
above- described check (s) for payment if it should come into my possession after the
filing of this affidavit.
5. I, Robert Bartolini, further understand that by presentation of this affidavit and the
issuance of a replacement check by the Maricopa County Education Service Agency that
I can be held legally liable both under criminal and civil laws of the State of Arizona if I
should accept to cash or present the above described check (s) to any bank, financial
institution, or any other party.
Subscrilyd and sworn to before me this
Signature of Affiant 'day of f-{)10 ,20l7.
ry Public
Notary Seal
/boar•Aloaraa0649,49..abak Plitholo Chignon a•–•
Missy tilseleops MSc - County Arizona
Sy Conunies4o4 May 11, 2019 Expires
411"I01900,•III•••I•••••"0".'"r".

GREATER GLENDALE FINANCE
P.O. BOX 4337
MESA, ARIZONA 85211
PHONE: 480 890 8101 FAX: 480 890 2108
FACSIMILE TRANSMITTAL SHEET
TO: FROM:
CARRIE — GARN DEPT Rita
COMPANY: DATE:
MCESA 2/22/17
FAX NUMBER: TOTAL NO. OF PAGES INCLUDING COVER:
602 372-8589 2
PHONE NUMBER: SENDER'S REFERENCE NUMBER:
602 372-4833 CC2015-070841RC
RE: YOUR REFERENCE NUMBER:
CYNTHIA RODRIGUEZ M-)LX-4631
0 URGENT 0 FOR REVIEW 0 PLEASE COMMENT 0 PLEASE REPLY 0 PLEASE RECYCLE
Per our conversation, attached please find Affidavit of Lost, Missing Check duly signed by
Robert Bart°lini, who is an officer of Greater Glendale Finance. We will also mail the original for
your files.
If you have any questions please call 480 890-8101.