030817 DUPLICATE WARRANTS 4_REDACTED.PDF

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: 2/7/2017
Please find attached 3 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.
#44 Avondale Lutrecia Spencer $38.21
#63 Aquila RCI Technologies Inc $600.00
#214 Tolleson Union Ana Ochoa $50.00
#47 Arlington Cori Kmetz $135.48

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: 121 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.
i/ke St)4-4./ (Ay-- (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about / )-- 17- (lo lc() (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 $ 3'g • 9-1 .(3)
(4)
Note: Please attach a ,f3Py 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 day of -e.,bru,u,k1 20 fl-.
AtG
NOkY PUBLIC OFFICIAL SEAL
AURA NELSON
Notary Public - State of Arizona
My commission commission expires: MARICOPACOUNIY I
My Cornm. Expires Dec. 28, 2019 !, (seal)
'earaI-I •••I •••I•• II • I ••••••• I •• I••••II•••I••••I •••••
Warrant/Check Number
(if known) (6) 11 0039 Li (-4(.0
Original Date of Issue ii - 1i- goio
(if known) (7)
Reason for original issue of Warrant/Check (8):
a Payroll
ERK, BOARD OF SUPERVISORS
0 For Services or Goods furnished MARICOPA COUNTY
El Treasurer's refund/payment
LI 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

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.
RCI Technologies, Inc. (I), being first sworn, upon oath deposes and says:
Name/Claimant
On or about jai-y Za (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/tile sum of $ 600.00 .(3)
Signed: (4)
(5),dcribed rd sworn to before me day of February 20 17 .
. z
41.h/.. .114 -Amy / /44111PA/AA/4/ /. .
ViPUBLI
.......... ULIZABETH SUE HERNANDEZ
My commission expires: A ';1,-1. Notary Public, Slate of Texas
My Commission Expires
In19y g, 20/S' May 03, 2018 (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 63Q39972
(if known) (6) 41700ot/4S/
Original Date of Issue 07/05/16 I
(if known) (7) *OZ.,
K. COJARD (..1 = `.1 iL, URS
Reason for original issue of Warrant/Check (8): MARICOPA COUNTY
D Payroll
I* For Services or Goods furnished Pxe0 gt-)Se 14/116Alrall 56.0/1065
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

February 3, 2017
TO: Whom It May Concern
RE: Schools Affidavit / Claim Form
Daniel W. Gibbens is the President and CEO of Records Consultants, Inc. DBA RCI Technologies, Inc., a
CorporAtion registerltd in the State of Texas, Mr. Gibbens is authorized to sign for the Corporation.
Elizabeth S. Viernandez
Controller
ESN/
Records Consultants, Inc. • 12829 Wetmore Road 9 San Antonio, Texas 78247 • Oifice: (877) 363-4127 • Fax: (877) 366-0776 • www.rcitech.com

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.
Ana Ochoa (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about November 3, 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 issued o him/her in the sum of $ 50.00 .( 3)
Signed: Atk..,K (4)
(5) Subscribed and sworn to before me this 50111 day o 20
A /-/-/
NOTARY ' UILIC
'CRYSTAL D. hiTCHEU.
My commi§sion_expires: Notary A1ARICOPA Pitt - St* olArtrona
ME.9°T"?1/36/°° COUNTY EViree (seal)
13, 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 470038722/214733784
(if known) (6)
Original Date of Issue 11/3/16 = FEBy 8 20
(if known) (7)
Reason for original issue of Warrant/Check (8):
▪ Payroll
▪ For Services or Goods furnished
• Other: Student refund
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc
Revised June 2015 A.R.S. 11-632 81.15-999

Affidavit
STATE OF ARIZONA
COUNTY OF MARICOPA )
4r! -Ktrod-z--
being first duly sworn, upon oath deposes and says:
That on the day of 4(4 , 20 he presented to the
of Maricopa County, for payment, a claim for services
rendered or supplies furnished during the month of u-St , said claim being
in the sum of Pri`€ ilit1 ldir6d71/ /rill five. al/./da Dollars ($ )
in payment of which the Superintendent of Schools caused his/her Warrant No. ,v70m,p&r
to be issued on , 20 , drawn on the Fund of
vatijotz
of Maricopa County, Arizona.
Affiant further says that although he was informed and believes that the above mentioned
warrant was regularly issued, the same has never been received or has been lost.
WHEREFORE, affiant prays that the Board of Supervisors order and the Superintendent of
Schools issue to him a duplicate of said warrant number /---7bw),4erwt in the sum of
$ /53/1
ov,
Subscribed and sworn before me this day of
I. /
OFFICIAL SEAL
tmcznit , St MELANIE FINCHUM
NOTARY PUBLIC -ARIZONA
MARIQOPA COUNTY
--!-131.112 My Comm Exptres 04 01 2019
My Commission Expires
Following approval please return this affidavit to the Maricopa County School Superintendent's Office.
HAWork1Affidavit.doc 07/14/05

MARICOPA COUNTY
Department of Finance
301 West Jefferson, Ste 960
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
Date: February 7, 2017
—0
To: Clerk of the Board
From: Beth Brown Cul
Department of Finance
Subject: Affidavit — Replacement of Lost Warrant
Please find attached affidavit for lost warrant to be included on the next available Board
Agenda.
• The attached item has been researched to ensure the warrant in question
has not been cashed or previously re-issued.
• The original warrant has a void/stale date/stop payment done.
Please call me at 506-1329 if you have any questions. Please return the approved
Affidavit to my attention in the Department of Finance, Suite 960.
Thank you.
Re: SHERRY PETERSON

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: I' Duplicate or El Stale-Dated (definitions are on page 2)
STATE OF ARIZONA Note: Numbers on this form correspond to
COUNTY OF MARICOPA numbers on the Instruction sheet which is
gape 2 of this form.
Sherry Peterson (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 15-Nov-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 issued to him/her in the sum of $ 46.02 .(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 I C141 day of ifit/dOrvie-Y 20 1 -7- .
LIDAAS
NOTARY 'PUBLIC YESSIKA VARGAS
Notary Public - Arizona
My commission expires: MARICOPA COUNTY
1Yr4J J,l 1 Expires 03r31/2019 (seal)
Warrant/Check Number 370009958
(if known)(6)
Original Date of Issue 15-Nov-2016
(if known) (7)
4
Reason for original issue of Warrant/Check (8): 08 2017
D Payroll
K, BOARD 0 SUPERVISORS
D For Services or Goods furnished MAR ICOPA COUNTY
D Treasurer's refund/payment
NI' Other: 11, Comp