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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: 12/19/2016 Please find attached 6 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. #214 Tolleson Union Rosemary C. Goolsby $452.64 #214 Tolleson Union City of Avondale $200.00 #214 Tolleson Union MSR West $210.00 #5 Isaac MSR West $970.00 #65 Littleton Learning Internet $3150.00 #45 Jacqueline Castillo Fowler $158.80 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 OUNTY OF MARICOPA Instruction sheet which is page 2 of this form. (1), being first sworn, upon oath deposes and says: me/Clai ant On or about October 13, 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 be issued to him/her in the sum of $ 452.64 .(3) (4) (5) Subscribed and sworn to before me this C day of 20 e 6Laitt4 NOTARY PUBLIC JOYCE C. COUNCIL My commission expires: Notary Public- State of Arizona // - .:,2(// My Commission MARICOPA Expires COUNTY Sept 11,2017 (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 470031883/214733196 (if known) (6) Original Date of Issue 10/13/16 (if known) (7) Reason for original issue of Warrant/Check (8): ▪ Payroll O For Services or Goods furnished gl Other: Costco Business Center items 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 -=.211 /TAMISPZE I received the missing check 44-70031883 from Tolleson Union High school District. 1 mailed it to our location 4827 but it was never received by them. I'm authorized to sign off on this affidavit, Thank you, Rosie Goolsby Costco Wholesale #691 10000 W McDowell Rood 0 Avondale, AZ 85392 0 623/907-5663 0 Fox 623/907-5680 0 www.coslco.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. City of Avondale (1), being first sworn, upon oath deposes and says: Name/Claimant On or about September 29, 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 jtfeisueolean/her in the sum of $200.00 43) Signed: (4) (5) Subscribed and sworn to before me this X— day of 20 \\ . NOTARY PUBLIC AMAPOLA MINEOLA My commission expires: NOUtry Maricopa Public County - Arizona s. My Comm, Expires May 11, 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 470027824/214732766 (if known) (6) Original Date of Issue 9/29/16 (if known) (7) Reason for original issue of Warrant/Check (8): Payroll For Services or Goods furnished Zoom Passes El Other: 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 December 5, 2016 Mr. Jonathan Escobedo Tolleson Union High School District 1#214 9801 W. Van Buren Street Tolleson, AZ 85353 Dear Mr. Escobedo, Please see the attached Affidavit / Claim Form from the City of Avondale requesting the Tolleson Union High School District to issue a duplicate warrant for $200.00 owed for Zoom passes sold. Gregory Luethje, our Senior Accountant signed the Affidavit and he is authorized to do so. Should you have any questions, please contact Gregory at (623) 333-2044 or by email at gluethie@avondale.org . Thank you. Sincerely, Abbe Yacoben Finance and Budget Director City of Avondale Enclosure Finance and Budget 11465 W Civic Center Drive I Avondale, AZ 85323 Phone (623) 333-2044 I Fax (623) 333-0200 I TDD (623)333-0010 I wvvw.avondale.org 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. Unna 131 . 41P/1512 bui,q- (1), being first sworn, upon oath deposes and says: Name/Claimant On or about December 7, 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/q(ecibe issued to higher in the sum of $ 210.00 .(3) Signed: laA4//1 /ej67L (4) / (5)-Subs _ jh ribed and sworn to b,efor "me this day of biCalAtar 20 / te9 . NOTARY PUBLIC JANA C. KESSLER NOTARY PUBLIC My commission expires: NOTARY STATE OF ID COLORADO 20084037868 MY COMMISSION BORES NOVEMBER 5,2020 (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 470025775/214732477 (if known) (6) Original Date of Issue 9/22/16 (if known) (7) Reason for original issue of Warrant/Check (8): 111 Payroll For Services or Goods furnished Audiometer Calibrations LI 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 WiSR West Your Local Equipment Exper',.s To whom it may concern: As requested, this letter states that Danna Pita is authorized to sign for e3 MSR West. Jana Kessler Office Manager 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. 3 nil S (1), being first sworn, upon oath deposes and says: Name/Claimant On or about iii/ Z0 (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/c ieckbe issued to him/her in the sum of $ 0," .(3) - /") Signed: (4) —SubTibed and sworn ore *this 1 41- day of bPeeWlber 20 AA WA NOTARY PUB IC JANA C. KESSLER My commission expires: STATE NOTARY OF COLORADO PUBLIC NOTARY ID 20084037888 l'/5I ZJ MY COMIASSION EXPIRES NOVEMBER 5,2020 (seal) Note: Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was ofiginally issued. I Warrant/Check Number (if known) (6) (t0 /13 7-M2 Original Date of Issue g /-Z;Z• / 2.01 I te (if known) (7) Reason for original issue of Warrant/Check (8): 0 Payroll For Services or Goods furnished 0 ;t4 I o 0 Other: S:\PROCESSES\Wrrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claindoc Revised June 2015 A.R.S. 11-632 & 15-999 MSR West Your Local Equipment Exoerts To whom it may concern: As requested, this letter states that Danna Pita is authorized to sign for e3 MSR West. Jana Kessler Office Manager Stop Payment Affidavit - STATE OF ARIZONA COUNTY OF MARICOPA The Learning Internet Inc. , being first duly sworn, upon oath deposes and states: That on the 25 day of August , 20 16 , he/she presented to Littleton Elementary School District No. 65, of Maricopa County, for payment, a claim for services rendered or supplies furnished during the month of August , said claim being in the sum of Three thousand one hundred fifty Dollars ($ 3,150.00 ) in payment of which Littleton Elementary School District No. 65 caused warrant/check number 470020901 to be issued on 8 day of September ,20 16 drawn on the warrant/check fund of Littleton Elementary School District No. 65 of Maricopa County, Arizona. Affiant further states that although he/she was informed and believes that the above mentioned warrant/check was regularly issued, the same has never been received, or has been lost. Wherefore, affiant requests that the Governing Board order and the Littleton Elementary School District No. 65 issue to him/her a replacement of said warrant/check number470020901 in the sum of $ 3,150.00 Subscribed and sworn before me this kbuvOo-r/K , 20 . OFFICIAL STAMP SARAH A. TRICE NOTARY PUBUC-OREGON COMMISSION NO. 938453 MY COMMISSION EXPIRES APRIL 26,2019 03/2013 Learning .com EXCEL IN A DIGITAL WORLD Learning.com Authorization This letter shall act as proof that Tim Hyre, VP of Finance, is authorized to sign off on the included affidavit stating that check #470020901 was not deposited by Learning.com . Please use the following link as a reference showing Tim's position with Learning.com . http://www.learninb.com/manaaement-team Learning.com 800.580.4640.1620 SW Taylor Street, Suite 100 Portland, OR 97205.www.learning.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. Jacqueline Castillo (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 08-12-2016 (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 $ 158.80 .(3) (4) (5) and pyyprn to before me this V't day of t ._./)C,C_, 20 My c7mmissfon expires: (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 45218628 (if known) (6) Original Date of Issue 08/12/2016 (if known) (7) Reason for original issue of Warrant/Check (8): Payroll • El For Services or Goods furnished El Other: S: \PROCESSES \Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claindoc Revised June 2015 A.R.S. 11-632 & 15-999 INTEROFFICE MEMORANDUM Waricopa County School . Superintendent's Office TO: CLERK OF VIE (B0AW9) FROM: MiCCie 'Thompson SUBJECT: Affidavits DATE: 12/19/2016 Pase find attached 5 AffidavitOotice of CCaim(s)for Cost warrants for incrusion on the ne.Kt avadaffe &)ard agenda 'The attached item(s) have been researched to ensure that the warrant(s) in question have not been cashed or previous Cy re-issued The original. warrant(s) have had a stop payment done. If you have any questions, p&ise contact Millie Thompson at 372-1244 or via e-mad at mthompson@mcesa.maricopa.gov . Approved Affidavits may be routed back to the Superintendent of Schoor 'Finance Division at 4041 N. CentrafAvenue #1200, ( 12 th Efoor) Thankyou. #60 Yfigrey I 00,Ar PEWCIVAL JR $406.01 (DENISE MA I) $152.02 10.11:91r 911 K,1911 $526.57 IliTlYfEW WILLER $756.10 glIAD-fEW MILLER $54.33 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. JOHN PERCIVAL JR (1), being first sworn, upon oath deposes and says: Name/Claimant On or about ?-\ ‘-t) (4° (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 $406.01 .( 3 ) Signed: (4) (5) Subscribed and sworn to fore me this 2— day ofbeCeYrIA -er-20 Notary AIMEE Public, E POMONIS State of Arizona MaricopeCounty My commission expires: My Commission May 15,2020 Expires D S I 15 j 2_ozc) 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 60492376 i 7 0 o ..?56 c, Co. (if known) (6) Original Date of Issue 12/08/2016 (if known) (7) Reason for original issue of Warrant/Check (8): Payroll 0 For Services or Goods furnished 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 Schools Affidavit/Claim Form wog 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. DENISE MAU (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 1/ - 3 - 70 IC- (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/che be issued to/ pim/her in the sum of $ 152.02 .(3) Signed: A (4) (5) Sjbscribed and sworn to before me this / 3 11(-- day of 41,62-146 201(0 . e MY NAVARRO Notary Public -State ot AlinA18 MAR1COPACOUNTY Expires Match 8, 2019! My corpmisision evires: • 0/d&/ (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 (if known) Number (6) 60490760 /i 003,1• q g -- Original Date of Issue 11/23/2016 (if known) (7) Reason for original issue of Warrant/Check (8): Payroll 111 For Services or Goods furnished LI 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 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. JOHN M KIM (1), being first sworn, upon oath deposes and says: Name/Claimant On or about (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 $ 526 . 57 43) Signed: (4) (5) Sub7s5ribed and swornzto--)efore me this I ‘3 day of becember-20 \Lp. t:7 M NOTARY PUBLIC AIMEE E POMONIS Notary Public, State of Arizona Maricopa County My commission expires: My Commission Expires May 15, 2020 ea I) 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 60490816 2)5 (if known) (6) Original Date of Issue 11/23/2016 (if known) (7) Reason for original issue of Warrant/Check (8): Payroll 111 For Services or Goods furnished El Other: S:\PROCESSES\Wai-rants - 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. MATTHEW MILLER (1), being first sworn, upon oath deposes and says: Name/Claimant On or about q-Z q- 2c7/c, (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 $ 756.10 .(3) Signed: (4) (5) Su cvibed ansLw/orn to before me this day of 1)4.7z..evv11o, 20 I Co . NOTARY PUBLIC r---------- OFFICIAL SEAL v` #_ LEAH CRUZ Notary Public -State of Arizona My commission qpires: MARICOPA COUNTY I My Comm. Expires Oct 28, 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 Number 170019628/60478174 (if known) (6) Original Date of Issue 09/29/2016 (if known) (7) Reason for original issue of Warrant/Check (8): Payroll 0 For Services or Goods furnished ID 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 i6c1 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. MATTHEW MILLER (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 2-- /5-- /4 (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 $ 54 .33 .(3) Signed: (4) (5) Subscribed and sworn to before me this 1C°— day of Or c,e4Joe( 20 ) (-79:1-4k, 10 OFFICIAL SEAL LEAH CRUZ Notary Public - State DIA:lama I My commission expires: MARICOPA COUNTY - )oi Comm. Expires Oct 26, 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 Number 170022807/60479693 (if known) (6) Original Date of Issue 10/13/2016 (if known) (7) Reason for original issue of Warrant/Check (8): Payroll III For Services or Goods furnished 111 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