120716 DUPLICATE WARRANTS 3.PDF

INTEROFFICE MEMORANDUM
Waricopa County School-Superintendent's Office
TO: CLERK OE TOE 00AXI)
FROM: Willie 'Thompson
SUBJECT: Affidavits
DATE: 11/14/2016
Pase find attached 1 Affidavit/Wotice of Craim(s)for Cost warrants for incrusion on
the ne.9c-t availa6Ce Ooard agenda
The attached item(s) have been researched to ensure that the warrant(s) in
question have not been cashed or previousey re-issued
The originar warrant(s) have had a stop payment done.
If you have any questions, p&tse contact .916121e Thompson at 372-1244 or via e-maiC 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
Eloor) Thankyou.
#0V(7(ETE VIV -10,X JO] N- fRISTT $319.19
.N. OV4 2018

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 pa ge 2 of this form.
John kri s-1-9 (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about H /i0 2OI Co (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/chec d to__IV/1-,ier_in the sum of $ 319 .19 .(3)
Signed: (4)
(5) Subscribed and sworn to before me this l COIL day of 4121/12446L 20 (/0
NOTARY PUBLIC
My commission expires: Notar y r. - Arizona
11)1q) iDtr7 .M..y, C,o,rn.„m,.. Maricopa jt=t ,Expires County Nov 14, 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
(if known) (6) 17002.96073
Original Date of Issue
(if known) (7)
Reason for original issue of Warrant/Check (8):
)4, Payroll
For Services or Goods furnished Frit—BE:ARP-I;
MARICOPA COUNTY
0 Other:
SAPROCESSESAWarrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of daim.doc
Revised June 2015 A.R.S. 11 632 & 15-999

MARICOPA COUNTY
Department of Finance
301 West Jefferson, Ste 960
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
CD
Date: November 14, 2016 3 7:1
7)
To: Clerk of the Board C:f 5 0 0 „ J
-V
From: Walter Chang • t x3 r 1;“,
Department of Finance 2-7 —
__4 cfl
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 506-8747 if you have any questions. Please return the approved
Affidavits to my attention in the Department of Finance, Suite 960.
Thank you.
Re: AZ DEPARTMENT OF ENVIROMENTAL QUALITY

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: Duplicate or El 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
bade 2 of this form.
AZ DEPARTMENT OF ENVIROMENT (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 01 -Sep -2016 (clate)(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 iss ed tor him/her in the sum of $ 375 .00 .( 3)
Signed: /1/1, (4)
Note: Please aterach 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 ';-X-10 day of 0e469/4/ 20
NOT • UBLIC
OPHELIA BEGAY
My commission expires: Public - Stab of Arizona
i-e1).11 1-X1X My isoV),ICOPA Comm1siiion COUNTY Expipas (seal)
February 11, 2011
Warrant/Check Number 00370004092
if known) (6
Original Date of Issue 01-Sep-2016
(if known) (7)
APPROVE
Reason for original issue of Warrant/Check (8): N14 7)i6
0 Payroll
O For Services or Goods furnished CLERK , MARICOPA BOARD OF COUNTY SUPERVISORS
O Treasurer's refund/payment
si Other: Warrant was never received and presumed lost.

ARIZONA DEPARTMENT
OF
ENVIRONMENTAL QUALITY
Douglas A. Ducey Misael Cabrera
Governor Director
Certified Mail
Return Receipt Requested
November 7, 2016
Kathy Baskom
301 W. Jefferson, Suite 960
Phoenix, AZ 85003
Subject: Application for Duplicate Check
Dear Ms. Baskom:
I Naveen Savarirayan, Manager of the Air Quality Compliance and Enforcement Unit of The Arizona
Department of Environmental Quality (ADEQ), am hereby authorized to sign on behalf of the
Department. Please remit check to:
Attn: Naveen Savarirayan
The Arizona Department of Environmental Quality
Air Quality Division,
Compliance and Enforcement Unit
1110 W. Washington Street
Phoenix, AZ 85007
If you have any questions, please contact me at (602) 771-2285.
NavEen Savarirayan, Manager
Air Quality Compliance and Enforcement Unit
Air Quality Division
Enclosures: Affidavit/Claim Form
Main Office Southern Regional Office www.azdeq.gov
1110W. Washington Street • Phoenix, AZ 85007 400W. Congress Street • Suite 433 • Tucson, AZ 85701 printed on recycled paper
(602) 771-2300 (520) 628-6733