120716 DUPLICATE WARRANTS 7.PDF

INTEROFFICE MEMORANDUM
Waricopa County School -Superintendent's Office
TO: CLEXKOE 004R9)
FROM: %tune Thompson
SUBJECT: Affidavits
DATE: 11/17/2016
Pase find attached 2 AffidavitOotice of Claim(s)for lost warrants for inclusion on
the neact avaiCa6 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 done.
If you have any questions, please contact Willie 'Thompson at 372-1244 or via e-mail at
mthompson@mcesa.maricopa.gov . Approved Affidavits may 6e routed 6ack to the
Superintendent of School finance Division at 4041 W. Central" Avenue #1200, ( 12 th
Eloor) Thankyou.
#2 RIVERSIDE QUEL 0.AWAVIS $ 1476.79
#5 ISAAC .S'COT1'511 PARSONS $1309.39

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.
Raquel Barajas (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about September 22 2016 (iate)(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 $ 1,476.79 .( 3)
Signed: (4)
(5)i d S bscribed and sworn to before me this 4- 0 '--day of Akkienthev io 4 6 .
A ,-----,) ,
NOTRY PUBLIC Maria Teresa Solares
Notary Public
Maricopa County
M commis§ion expires: Arizona
r- My Comm. (seal)
Expires August 2, 2018
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 170017746
(if known) (6)
Original Date of Issue September 22, 2016
(if known) (7) A it)PROVI
Reason for original issue of Warrant/Check (8):
gl Payroll
El For Services or Goods furnished K, MARICOPA BOARD OF COUNTY SUPERVISORS
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

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.
ft /. /Jat50/')._S (1), being first sworn, upon oath deposes and says:
Name C airnant
On or about / ti /201((,) (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 $ 1, 309 . 3? .(3)
Signed: pct,r3on8 (4)
(5) Subscribed a d worn to befor9„me this -1-h day of Novem be/Jr 20 /(p .
NOTARY PUBLIC OFFICIAL SEAL
. SANDRA APONTE i
My commision expires: Nolan/ Public-SW*00Am
/ MARICOPA COUNTY
LH ;g 2O16 My Comm. Expires Aprfl 11, 20201 (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)
Original Date of Issue
(if known) (7) APPROVED
Reason for original issue of Warrant/Check (8):
X Payroll
1=1 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

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: 11/17/2016
Please find attached 1 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.maricolda.`gov. Approved Affidavits may be routed back to the
Superintendent of School Finance Division at 4041 N. Central Avenue #1200, (12th
Floor) Thank you.
#5 Isaac Yvonne Gonzalez for Woodwind & Brasswind $709.56

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.
YBAintiKt 1-6Z—, (1), being first sworn upon oath deposes and says:
for Wet.)05U,r) I ricL ti -NorckS hcL
On or about May LOU, (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/cbe* be issued to him/ r in the sum of 4)9, 540 .(3)
Signed: (4)
(5) Subscribed and sworn to before me this d/ld day of kJ upik/oc 20 /b.
/ ,
_ 11111- _,T.1111111111Mia-reaeviamisrign4.0111111
NOTARY PUBLI Commission # 2079660
r Notary Public - California
Riverside County
My commission expires: Comm. Expires(Aug 28, 2018
AL.t (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 i—keolOote9F
(if known) (6)
Original Date of Issue
(if known) (7) 60-1/LP
AP
Reason for original issue of Warrant/Check (8):
CI Payroll
El For Services or Giods fypished
MARICOPA COUNTY
je Other:
SAPROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claindoc
Revised June 2015 A.R.S. 11-632 81.15-999

CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE § 8202
a- a- ^ • a a- - a a- a. at-- a at..6%, a- a a- a a- a. a- a- a, a- a
XSee Attached Document (Notary to cross out lines 1-6 below)
0 See Statement Below (Lines 1-6 to be completed only by document signer[s], not Notary)
Signature of Document Signer No. 1 Signature of Document Signer No. 2 (if any)
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California Subscribed and sworn to (or affirmed) before me
County of LDS
on this . --:)(-)01 day of MO Veltther , 20/ lc"
by Date Month Year
(1) \*(V ormt2 brl -Lia
(and (2) ),
Name(s) of Signer(s)
DOROTHY C. MADISON
Commission # 2079660 _ proved to me on the basis of satisfactory evidence
Notary Public - California § to be the person(s) who appeared before me.
Riverside Qounty
My Comm. Expires' Aug 28, 2018
Signature 0(104_,L0(\
Signattfre of Notary Public
Seal
Place Notary Seal Above
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document: APP1 ((At b I-•( Dkpli e Ciircle-- Document Date: PD
Number of Pages:Olt, Signer(s) Other Than Named Above: 00 0-t4!p_r 3 pow-CS
©2016 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item 45910

WOODWIND rip-I
Na11111
BRASSW I NEI
November 2, 2016
Isaac School District #5
4135 W Thomas Rd
Attn: T. Valtierra
Phoenix, AZ 85019
Woodwind & Brasswind Account number 844298
Dear Customer,
See attached affidavit to replace lost check for $709.56 that was sent to us in May 2016, but we did not
ever receive.
Thank you for your assistance with this!
Kind regards,
Yvonne Gonzalez
Account Specialist —Collections Accounts G-N
Guitar Center/Woodwind & Brasswind/Musician's Friend/Music123
Westlake Village, California 91359
yvonne.gonzalez@guitarcenter.corn
800.584.6465 ext. 2697