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INTEROFFICE MEMORANDUM 9frfaricopa County School -Superintendent's Office TO: CLERK OE TOE FROM: 9Kitrie Thompson SUBJECT: Affidavits DATE: 2/13/2017 Pase find attached 2 AfficiavitOotice of Craim(s)for Cost warrants for incrusion on the next avaifaôCe Ooard agenda The attached item(s) have 6een researched to ensure that the warrant(s) in question have not 6een cashed or previousey re-issued The original. warrant(s) have had a stop payment done. If you have any questions, pase contact Mew Thompson at 372-1244 or via e-mait at mthompson@mcesa.maricopa.gov. Approved _Affidavits may he routed 6ack to the Superintendent of School - T'inance (Division — • at 4041 W. Central. Avenue #1200, ( 12 th Efoor) Thankyou. #65 L ITO-WELD cyfELsEA (11LLT $1476.51 #17 TOLLE80,9 I1- ELE14 ARIZONA CENTER TOR ATTER SCYCOOL EXCELLEWOE $85.00 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. Arizona Center for Afterschool Excellence (1) being first sworn, upon oath deposes and says: Name/Claimant On or about 12/14/2016 (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 er in the sum of $ 85.00 43) Signed: (4) (5) Subscribed and sworn to before me this -7 -1-L day of re-6(0c-iil 20 V7. LI NOTARY PUBLIC OFFICIAL SEAL My commission expires: 1.1 Notary JOSEPH Public - State FOLAN of Arizona oi /010 P0/9 My MARICOPA Comm. Expires January COUNTY l',31141j 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 470050851 FEB 3 201 J (if known) (6) - , Original Date of Issue 12/14/2016 0 (If known) (7) IHK 3UI11U ur -.-- ,,rr,v • lSOR `z, MARICOPA COUNTY Reason for original issue of Warrant/ Check (8): El Payroll 14 For Services or Goods furnished fl161.frssi ma I doclopm0A-1 co41erem rejisfo-im o Other: S:\PROCESSES\Warrants - Duplicate or Stale \02 Forms\Schools\Schools-Warrants Checks notice of clalm.doc Revised June 2015 • A.R.S. 11-632 8i 15-999 Arizona Center for Afterschool Excellence BOARD OF DIRECTORS February 10, 2017 Irene J. Burnton, President College of Public Service & Community Solutions Arizona State University Amy Brown Kirk Astroth, Immediate Past President Finance Specialist I Accounts Payable Arizona 4-H Youth Development Tolleson Elementary School District No. 17 Josh Glider, President-Elect 9261 W. Van Buren Kyrene School District Tolleson, AZ 85353 Sandy Foreman, Secretary Early Childhood Systems Consultant Jeanette Ramos, Treasurer CliflonLarson Allen LLP Ms. Brown: Leigh Critchley Grand Canyon University This letter is to inform you that Courtney C. Sullivan, Executive Director, is Barham Ervin an authorized signer for the Arizona Center for Afterschool Excellence. Deer Valley Unified School District Lupita Hightower, Ed.D Superintendent Tolleson Elementary School District Joseph Ortiz Edward Jones Aaron Secakuku Native Americans for Community Action Courtney C. Sullivan Cindy Trejo Executive Director 21st Century Community Learning Centers Arizona Center for Afterschool Excellence Arizona Department of Education Tim Valencia Office of the City Manager City of Phoenix The Honorable Corey Woods Former Vice Mayor, City of Tempe ASU Preparatory Academy EMERITUS BOARD JoAnne Hilde The Education Coalition The Honorable Ruth Solomon Former Arizona Stale Senator The Honorable Carolyn Warner Former Arizona Superintendent of Public Instruction CorporateEducatton Consulting. Inc. 77 Lost Weldon /55(00 tel 002 .(34 04241 azartecs'chool.org 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 form correspond to numbers on the COUNTY OF MARICOPA Instruction sheet which is page 2 of this form. /,-//y ( 1), being first sworn, upon oath deposes and says: NadiOanalf;f5e On or about a,zo her c-.7g r ,_9(2/(4ciate)(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 $ 97&, , .(3) Signed: (4) Note: Please attach a d the warrant/check if available and/or any other evidence that a warranVchglcwas originally issued. (5) Subscriberanci swor to b fore me this /VII day of cuAme,v/ 20 NOTARY PUBLIC Oscar Lozoya Notary Public My commissior expires: Maricopa County, Arizona ‘..‘ My Comm. Expires 04-12(10a Warrant/Check Number (if known) (6) 700c356, a (0 Original Date of Issue (if known) (7) eo1p for original issue of Warrant/Check (8): Payroll 0 For Services or Goods furnished 0 Treasurer's refund/payment 0 Other: SAPROCESSES\Warrants - Duplicate or Stale \02 Forms\Warrants Checks notice of claim - Copy.doc Revised April 2015 A.R.S. 11-632 & 11-614