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INTEROFFICE MEMORANDUM - _ Waricopa County School -Superintendent's Office TO: CLERK OE' 'ME (:)./4cR9D FROM: ititrie Thompson SUBJECT: Affidavits DATE: 1/30/2017 Pase _find attached 2 Affidavit/Notice of Claim(s)for Cost warrants for inclusion on the next availaôle Ooard agenda The attached item(s) have 6een researched to ensure that the warrant(s) in question have not 6een cashed or previously re-issued The original-warrant(s) have had a stop payment clone, lf you have any questions, please contact Millie 'Thompson at 372-1244 or via e-mail at mthompson@mcesa.maricopa.gov . Approved Affidavits may 6e routed flack to the Superintendent of School 'Finance (Division at 4041 X Centrar)venue #1200, ( 12 th Efoor) Thankyou. #44 AVONDALE ANDREA L'UNA $223.30 #44 AVONDALE :MEGAN . L A9140REAVX $1238.52 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form #14(-1 This application is for: El Duplicate or El 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. a (1), being first sworn, upon oath deposes and says: Narr On or about 3 - 3 - .01,40 (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 in the sum of $ Q23. So .(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 /9-01 day okfrv 20/' . ,NO)t-A Y UbLIC ,-.10.1.. . .6• I •••I•I • • .=•••I••• I ••••I•••••• •• I• • • I•• (7 OFFICIAL SEAL ! )1y commission expires: LAURA VERA j Notary Public - State of Arizona i MARICOPA COUNTY ! (seal) My Comm. Expires Aug. 31, 2017 ! Warrant/Check Number (if known) (6) 0D 626 -3'30 Original Date of Issue (if known) (7) 3 - 3- ge Reason for original issue of Warrant/Check (8): 1:21. Payroll O 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 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: II 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. A atlatAtr1 ifra_ore6 t19)(being first sworn, upon oath deposes and says: ame aimant On or about /i—) 7 — (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 $ i/ P3 43• 5 .(3) Signed* 'A _I.,' • AMIA• .I_441 4-, 0. (4) Note: Please attach a copy of the wa'rrant/check if available and/or any other evidence that a warrant/check was originally issued. (5) Subscribed and sworn to before me tIlis 2-5M day of Jan. 201R- . Pc AA NOTARY PUBLIC —.6-Fk-14.8EAL My commission expires: Notary AURANELSON Public - State of Arizona ; ipeeernb-e-r 201q MARICOPA COUNTY (seal) MC% My Comm. Expires Dec. 28, 2019 ! Warrant/Check Number (if known) (6) 11") O 3,9 L1D3 Original Date of Issue (if known) (7) 11-1 -7-oUp Reason for original issue of Warrant/Check (8): NI Payroll D For Services or Goods furnished D Treasurer's refund/payment 0 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