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INTEROFFICE MEMORANDUM Waricopa County School -Superintendent's 0 TO: CLER( OE 'ME cB 014 R9) FROM: WitTie 'Thompson SUBJECT: Affidavits DATE: 2/24/2017 Pase find attached 1 AffidavitOotice of Craim(s)for Cost warrants for inclusion on the nek-t 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 4 The original- warrant(s) have had a stop payment done. If you have any questions, p lease contact %farm 7fiompson at 372-1244 or via e-mail at at mthompson@mcesa.maricopa.gov . :Approved Affidavits may be routed back to the Superintendent of School finance Division at 4041 ,9V: Central- Avenue #1200, ( 12 th 'Floor) Thankyou. #44AVONDALE 1,45VIES K,CROWTHER $180.99 RECEIVED MAR 0 1 2.017 MARICOPA COUNTY CLERK BOARD OF SUPERVISORS Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: 12I 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. attioes -k^ dbt-L-31-hgr- (1), being first sworn, upon oath deposes and says: _i) ame/Claimant On or about `3 / 40 (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 ie sum of $ I O. 99 .(3) Signed: (4) Note: PI6ase attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. (5) Sibscribed and sworn to before me this ga rtci day of RbruDull 20 19' OFFICIAL SEAL '1 AURA NELSON j Notay Public - State of Arizona My commission expires: MARICOPACOUNTY I llon.. .I • II•••••••••••••• My Cann I•••.....•••I•• E*Ires Dec. I• 28,2019 ••I••••••• ! (seal) Warrant/Check Number (if known) (6) *40o ) 91 1 1 Original Date of Issue (if known) (7) Reason for original issue of Warrant/Check (8): M Payroll O For Services or Goods furnished O Treasurer's refund/payment [1] Other: S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc Revised April 2015 A.R.S. 11-632 & 11-644 JzOri