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INTEROFFICE MEMORANDUM Ilaricopa County School'Superintendent's Office TO: CLERX OE gliftE WARD FROM: MITie 'Thompson SUBJECT: Affidavits DATE: 2/9/2017 Tase find attached 1 Affidavit/Notice of Cfaim(s)for Cost warrants for inc fusion on the next avada6fe Ooard agenda •\1 The attached item(s) have 6een researched to ensure that the warrant(s) in question have not been cashed or previousCy re-issued: The original. warrant(s) have had a stop payment done. .11- you have any questions, prease contact Millie Thompson at 372-1244 or via e-mail - at mthompson@mcesa.maricopa.gov. Approved Affidavits may 6e routed 6ack to the Superintendent of School finance Division at 4041 N. Centraf Avenue #1200, ( 12 th ECoor) Thankyou. #44 AVONDALE OEMANY NELSON $3478.55 RECEIVED FEB 0 92017 riiiikrACA 3 CLERK EiON't1; (6. Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: CI Duplicate or 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. i2d-c,11hotn\I D Y1 (1), being first sworn, upon oath deposes and says: ame/Claimant On or about 11/17/2016 (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/c1- ck be issued to him/her in the sum of $ 3,478.55 .(3) Signed: PI/A (4) Note: Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. and sworn to before me this i 1 --)A4N day of okt/tAio,"( 20J NOTARY DAVID TIES MA Notary Public - Michigan My commission expires: Ottawa County 3 (b2c> My Commission Expires JjiI 30, 204seai Acting in the County of Warrant/Check Ni imher a (if known) (6) 17 OD 3 0? Original Date of Issue 11/17/2016 (if known) (7) Reason for original issue of Warrant/Check (8): I* Payroll CLERK, BOARD OF SUPERVISORS MARICOPA COUNTY ▪ For Services or Goods furnished O Treasurer's refund/payment O 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 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: 2/9/2017 Please find attached 5 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. #95 Queen Creek William Schultz $629.10 #95 Queen Creek Rilar Crewse $5.97 #216 Agua Fria AASP $480.00 #216 Agua Fria Musco Sports Lighting $153.54 #5 Isaac B&S Supply/William Frazier $1708.01 RECEIVED FEB 0 9 2017 MARICOP.':\ CCYJNTY CLERK BOARD OF SUPERVISORS i lo 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. William Schultz (1), being first sworn, upon oath deposes and says: Name/Claimant On or about July 12, 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 $ 629.10 .(3) Signed: (4) sworn to before me this 3r4 day of Fib LORI ANN PLAITS My commission expires: 14otaryPttlo-919sciftone WIFOCOPACOUNTY July 12, 2016 My Commission EviNi (seal) Mu 2. 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 4-7-0003314 (if known) (6) Original Date of Issue 7/12/16 At F E 0 W (if known) (7) ulf0, 17 `415, 1, Reason for original issue of Warrant/Check (8): 0 Payroll 0 For Services or Goods furnished Travel Reimbursement I* Other: Travel Reimbursement SAPROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc Revised June 2015 A.R.S. 11-632 & 15-999 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. Pilar Crewse (1), being first sworn, upon oath deposes and says: Name/Claimant On or about rNk. r ès, 1 \•16\\.) (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 pd to him/her in the sum of $ 5 .97 .(3) Signed: (4) cribed and sworn to before me this 1 441 day of E--62 20 ti . LORI ANN PLATTS My commission expires: Notary MARICOPA Pubis. Stale COUNTY olkluona 31.31/9 My Comnission May 2, 2012 &pima (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 46-0111660 (if known) (6) Original Date of Issue 6/14/16 102p (if known) (7) Reason for original issue of Warrant/Check (8): 0 Payroll 0 For Services or Goods furnished Meal travel reimbursement Other: Meal travel reimbursement 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 AFFIDAVIT APPF STATE OF ARIZONA DATA FEB 0 lir .,iA(WW49 COUNTY OF MARICOPA G\ 1/4 rz. ZoriA AS6oci47ro o \y' ..,x\)-‘-, 3c ti ?SYc i-to to sTs , being first duly sworn, upon oath deposes and says: That on the 21 day of /k/ov 20 up , he presented to AFv 0- zup District of Maricopa County, Arizona, for payment, a claim for services rendered or supplies furnished during the month of It) cAlEm 8Ev: 20 14o , said claim being in the sum of -;•ur )41.4..rb4ze 1T%j Dollars, ($ Ltwo , cc) ) in payment of which the Superintendent of Schools caused his/her Warrant Number '17-00 tisns to be issued on AkvE-tei5ce 29 , 20/to , drawn on the 2 Fund of 12/to District of Maricopa County, Arizona. Affiant further says that although he/she 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/her a duplicate of said Warrant Number LinottSti55. infthe sum pf $ ii(40 . 00 /11 Signed: ( Subscribed and sworn to before me this day of ,20 \ .1 n 7) 1 My commission expires:--- 1 - NOTARY PUBLIC • Following approval please return this affidavit to the Maricopa County School Superintendents Office. JAMES CHRISTENSEN NOTARY PUBLIC, ARIZONA MARICOPA COUNTY My Commission Expires June 11, 2018 Arizono Associotion a School Psycho1ogists To Whom It May Concern: I Coral Votroubek, Executive Director of AASP, am an authorized user to stop payment of any AASP checks. All checks and payments should be made to AASP at the following address: 107 S. Southgate Dr. Chandler, AZ 85226. Please do not hesitate to contact me with additional q uestions. Thank you, Coral Votroubek Executive Director Arizona Association of School Psychologists 107 S. Southgate Drive Chandler, AZ 85226 P: (602) 992-0554 I F: (480) 893-7775 APPMED AFFIDAVIT FEbO247 DA STATE OF ARIZONA , BOARO OF SUPER' MARICOPA COUNT COUNTY OF MARICOPA Vals_co_ 5ps45 IAix Li-e , being first duly sworn, upon oath deposes and says: That on the 1„.Ck day of Noti 20 ao, he presented to WI 143b• District of Maricopa County, Arizona, for payment, a claim for services rendered or supplies furnished during the month of 1\6. 2 20 kip, said claim being in the sum of ifr Jthiars, ($ 1576.54) in payment of which the riC1"/ T-DV02- LPI11-5 Superintendent of Schools caused his/her Warrant Number 4700-1-56i31 to be issued on gm/. 29 , 20119 , drawn on the 06\ Fund of Art/tViSb District of Maricopa County, Arizona. Affiant further says that although he/she 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/her a duplicate of said Warrant Number COL1-50157 in the sum of $ M3.54 Signed: _,S/eIF)> 71/1-4-C Subscribed and sworn to before me this J d ,201 —7 NOTARY PUBLIC My commission expires:, Following approval please return this affidavit to the Maricopa County School Superintendents Office. TACY HAWK Notarial seal - Iowa Commission # 721325 My Commission Expires ,7 100 1st Ave West • PO Box 808 • Oskaloosa, IA 52577 • 6411673-0411 • 800/825-6020 , Fax: 641/673-4852 Web: www.musco.com • Email: lighting@museo.com Brad Ma roll is an authorized signer and employee for Musco Lighting. Mark Kivett Credit Dept Mgr - JILL A SANDEEN Commission Number 711884 ,16th . My Commission Expires August 7, 2019 Lighting. . . We Make It Happen. 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 MARICppA Instruction sheet which is page 2 of this form, \-) cLq, TVA-\ (1), being first svvorn, upon oath deposes am. says: N metdaimant On or about \\ 1\A (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. ;4 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) Signed: ,fr,/,4 /Lig f (4) (5) S rib and swowio before me this '& day of NOTARY PUBLIC PETRA H. ROBLE5 NOTARY PUBLIC - ARIZONA My co mission expires: My MARICOPA Commission COUNTY Expires /lane) c=1- .140 March 25, 2019 (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 (i f known) Number (6) ,„..At r---$ \ 23 (:)k.,A , , rs i b. , c.--,,, --) \ — Original Date of Issue (if known) (7) \ \ I\ \( i \ \, 1, . FEN 01017 Reason for original issue of Warrant/Check (8): LI Payroll CLERK, BOARD :zAJPERVISORS MARICOP, , COUNTY )S1 For Services or Goods furnished LI Other: SAPROCESSESWVarrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claindoc Revised June 2015 A.R.S. 11-632 & 15-999