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INTEROFFICE MEMORANDUM 5ilaricopa County School-Superintendent's Office TO: CLERK OE VIE 0)4 R9) FROM: Willie 'Thompson SUBJECT: Affidavits DATE: 1/24/2017 Prease find attached 1 Affidavit/Xotice of Craim(s)for Cost warrants for inclusion on the net avada6le Ooard agenda The attached item(s) have 6een researched to ensure that the warrant(s) in question have not been cashed or previously re-issued •Ni The original' warrant(s) have had a stop payment done. If you have any questions, please contact 911iffie Thompson at 372-1244 or via e-mail at mthompson@mcesa.maricopagov. Approved Affidavits may 6e routed 6ack to the Superintendent of School finance Division at 4041 W Central - Avenue #1200, ( 12 th TThor) Thankyou. #5 ISAAC WARIA CIO 5141REZ $1201.38 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. p. ieampez (1), being first sworn, upon oath deposes and says: Name/Claiman On or about / 4/17 (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 $ 20/ 38 .(3) Signed: -7 1144C-C (4) ibed and swor o before me this / -7 day of 201 NOTARY PUBLIC . ,...e.•••II ••••II •••I•••I••••••••••••I••••I••• OFFICIAL SEAL I•••••I ••I •I •,, ! I . SANDRA APONTE 1 My commis vpires: Notary Pubic- State olAnZ01111 MARICOPACOUNlY / 1/ 76.3107 *Comm. Ecirea April 11, 2020 (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 17 (if known) (6) Original Date of Issue 1 1(2/// 7 (if known) (7) / Reason for original issue of Warrant/Check (8): ik Payroll 0 For Services or Goods furnished Vc" BOARD OF SUPERVISORS eetltat-v 0 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