011117 DUPLICATE WARRANTS 9_REDACTED.PDF

INTEROFFICE MEMORANDUM
Waricopa County School-Superintendent's Office
TO: CLEVCOE TOE 00ARD
FROM: Willie 'Thompson -
SUBJECT: Affidavits
DATE: 12/22/2016
Pase find attached 3 AffidavitrnOtice of Claim(s)for Cost warrants for inclusion on
the next available Ooard agenda
The attached item(s) have been researched to ensure that the warrant(s) in
question have not been cashed or previously re-issued
The original warrant (s) have had a stop payment done.
If you have any questions, please contact Millie Thompson at 372-1244 or via e-mail at
mthompson@mcesa.maricopa.gov . Approved Affidavits may be routed back to the
Superintendent of School - 'Finance Division at 4041 X Central* Avenue #1200, ( 12 th
'Floor) Thankyou.
#60 Yfigfey ROSE 1'1A STONE LTD $7,728.33
#49 PALO VERDE JERKY GAWLEW $1 766.88
#65 LneiLETON KV -DINA SESSLER $392.29

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 MAR1COPA Instruction sheet which is page 2 of this form.
Rosetta Stone LTD. (1), being first sworn, upon oath deposes and says;
Name&taimant
On or about 1 10 .0r\. - 1 1 9 - (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 shwn is due and owing, and the applicant requests that a replacement
warrant/check .(3 )
Signed: f )91 (4)
Commonwealth/State of
The4eregoifig4fistroment-was-ackflowledgett
before me iiti3.02/,_day of
20& by uy /-4 ,. A elcr---r
My corni.niss:on, expires: friarneionseeki
/7-F/ LW NotaryTiTlic
tt*C-01}1filigi3
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 470037141
(if known) (6)
Original Date of Issue 11/01/2016
(if known) (7j
Reason for original issue of Warrant/Check (8):
LI Payroll
For Services or Goods furnished 6141We, Crare_s_510-2q,i DRi)ei op rizu21C4
El Other:
S:\PROCESSES\Warr-dnts - Duplicate or Stale \02 Forms\Schcols\Schools-Warrants Checks notice of clairo.doc
Revised dune 2015 A.R.S. 11-632 & 15-999

Lisa G. Bate
Accounts Payable Specialist
Higley Unified School District #60
2935 S. Recker Rd
Gilbert, AZ 85295
480-279-7043
480-279-7509 fax
Lisa,Bate@Husd,Org
Lisa,
Please see attached signed Affidavit stating that we have not received the check
in question.
Desk: 01.540,236.7692
Mobile: 01.215.272.7343
ishelly@rosettastone.com
135 West Market Street, Harrisonburg, VA 22801 USA RosettaStone.com 800.788.0822

AFFIDAVIT
APPROVED
STATE OF ARIZONA DATR Da? 7 2Q
COUNTY OF MARICOPA RFC ; BOARD OF SUPF_RV!SORS
MARCOr'.A CC!_;N:7,
I
)c , being first dul y sworn, upon oath deposes and sa ys:
That on the 01-k day of ZefitAtilir 20[(ô, he presented to Palo Verde
Elementary School District of Maricopa Count y, Arizona, for pa yment, a claim for services
rendered or supplies furnished durin g the month of See-krytiatr , 20 I L,
said claim bein g in the sum of CvitditotoaRti getWA ktoutrea Alico Dollars,
($ LI 6(0. 0S ) in payment of which the Superintendent of Schools caused his/her Warrant
Number 1-11=A3QA) to be issued on Sep-i-elniatr zo 110,
drawn on the ('Ai Fund of Palo Verde Elementary School District of Maricopa Count y, Arizona.
Affiant further sa ys that although he/she was informed and believes that the above
mentioned warrant was re gularly issued, the same has never been received, or has been lost.
WHEREFORE, affiant pra ys that the Board of Supervisors order and the Superintendent
of Schools issue to him/her a duplicate of said Warrant Number 4-700a43e.& in
the sum of $ I 166
Signed:
,7
Subscribed and/ worn to before me this 151 4 day of DA
JODIE H. MEYER
ID# 2169344 NO/ARY PUBLIC
My commission expittscoramission.a9408443,120 NOTARY PUBLIC OF NEW JERSEY
4-9—
Following approval please return this affidavit to the Maricopa County School Superintendents Office.

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.
k Y- S v-ga ess (1), being first sworn, upon oath deposes and says:
me/Claimant
On or about -'-c --j ao'Le (date)(2) a warrant/check was issued to the
above named person/enti 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 $ 39ci. 079 .(3)
Signed: (4)
(5) ttb cribed and sworn tAefory (i'me this day olz-ti,t_be r 20
C2,1zi4
11111C
Anamarla OulntanIlla
My commission expires: Marlcopa Notary County, Public Arizona
% My Comm, Expires 05-15-18 (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
(if known) (6) / 10005-1439 6
Original Date of Issue
(if known) (7) / — a — e' 1 40 DATA DE12 7 2016
Reason original issue of Warrant/Check (8):
rrrayroll
0 For Services or Goods furnished
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

Maricopa County
Human Resources
Fran McCarroll, Clerk of the Board
From: Wanda Childers
Date: December 27, 2016
Re: Replacement of Lost Payroll Warrants
Please find find attached I Affidavit/Notice of Claim(s) for lost
payroll warrants for inclusion on the next available Board agenda.
The attached item(s) have been researched to ensure that the
warrant(s) in question have not been cashed or previously re-
issued. The original warrant(s) have had a stop payment done.
Please call Wanda at ext. 60409 for any questions. Please route
approved Affidavits back to County Payroll, Suite 220.
Stale Dated Warrant Duplicate Warrant
Thank you.
Replacement Lost Warrant Form 1 02/25/2015

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: IR 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.
Judith Lillian Strom (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about November 30, 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 $ 140.00 .(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) ubscribed and sworn to before me this Zilld" day of me.' hf-(-- 20 /6 .
OTARY PUBLIC
JOSE L. HOLGUIN, JR.
My commission expires: Notary MARICOPA Pubic - State COUNT,' of Adoria
Apitli 24) Zlniff My Commission April 24, 2019 Expinss (seal)
Warrant/Check Number 22441353
(if known) (6)
Original Date of Issue 11/30/2016
(if known) (7)
Reason for original issue of Warrant/Check (8):
Payroll
APPROVED
I=1 For Services or Goods furnished 2.7 7.916
D AT
EI Treasurer's refund/payment
I=1 Other:
Revised April 2015 A.R.S. 11-632 & 11-644

MARICOPA COUNTY
Department of Finance
301 West Jefferson, Ste 960
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
Date: December 27, 2016
To: Clerk of the Board
From: Nadine Higuera
Department of Finance 0
Subject: Affidavits — Replacement of Lost Warrants
Please find attached 1 Affidavits for lost warrants to be included on the next available
Board Agenda.
• The attached items have been researched to ensure the warrant in question
have not been cashed or previously re-issued.
• The original warrants have a void/stale date/stop payment done.
Please call me at 506-1354 if you have any questions. Please return the approved
Affidavits to my attention in the Department of Finance, Suite 960.
Thank you.
Re: MICHELLE L SOLOMON

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: Fl Duplicate or 0 Stale-Dated (definitions are on page 2)
STATE OF ARIZONA Note: Numbers on this form correspond to
COUNTY OF MARICOPA numbers on the Instruction sheet which is
gage 2 of this form.
(1), being first sworn, upon oath deposes and says:
LenieVaincant L5()/11 /"Al
On or about 15-Nov-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 pedury, claimant hereby affirms that this claim is correct
and the amount shown is due and owing, and the applicant requests that a replacement
warrant/chect< Abe issuk to him/her in the sum of $ 931 -67 .(3)
Signed: (4)
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was ofiginally issued
pm t9 before me this 5, day_of 20 1' .
My commission expires: Melynda Marie Pierre-Louis
- Notary Public (seal)
IlaticapaLaw444tizona
Warrant/Check Number 370009940 My Comm. Expires 09-17-18
(if known) (6)
Original Date of Issue 5-Nov-2016
(if known) (7)
Reason for original issue of Warrant/Check (8): APPROV LAi
O Payroll
O For Services or Goods furnished
O Treasurer's refund/payment
Other: Victim Claim

301 WEST AFFERSON STREET, 9TH FLOOR FAX PH. (602) (602) 372.0197 606-4955
PHOENIX, WWW.MA RI ARIZONA COF'AC OLI 85003 NTYATTORN E Y.0140 TOD (602) 5064352
Alaticopa Coutitp Zittornzp
SILL mc)N4.1 GONIERY
November 14, 2016
MICHELLE SOLOMON
RE: Victim Compensation Case #: VC2016000290- 1
Hearing Date : 11/09/2016
The Victim Compensation Board took the following action on your claim:
Request Number: 5 Service Type: MILEAGE - MENTAL HEALTH
The Victim Compensation Board approved payment of $931.67.
Date of Service 11/4/2015-09/28/2016 (33 DOS)
Pay to: MICHELLE SOLOMON
Based on the Subrogation Agreement that you signed during the completion of the original
application, monies received from restitution/settlements/insurance MUST be reimbursed to the
Victim Compensation Program.
Please feel free to call us at (602) 506-4955 if you have any questions. If you feel this decision
is in error, you have (30) days from the date of this letter to appeal this decision in writing.
You must provide additional information and supporting documentation to appeal the decision.
Sincerely,
GREEN
Victim Advocate
Victim Compensation Services
(602) 506-4955
greenjOl®mcao.maricopa,gov