120716 DUPLICATE WARRANTS 11_REDACTED.PDF

INTEROFFICE MEMORANDUM
Waricopa County School -Superintendent's Office
TO: CLERK OE(191rE
FROM: MITie Thompson
SUBJECT: Affidavits
DATE: 12/1/2016
Prease find attached 1 Affidavit/Notice of Craim(s)for Cost warrants for inclusion on
the next availaôle Ooard agenda
-\1 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 Millhe Tfiompson 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.
#5 ISAAC VVII{ERINE E GIVIVAN $981,23

•
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.
.
IC4 661 ,1141, e iniyott (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 $ 2. 3 .(3)
Signed: (4)
(5) Subscribed and sworn to before me this cp-- /1 / day of ON
NOTARY P OFFICIAL SFAL
RYAN FRENCH I
My commission expires: HornPublic- No MARICOPA Stitt COUNTY olkizons
"51 2.4 2.0 • IN" 131 (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 0 60 2---) au
a)_/ <nown j 6
Original Date of Issue .!•-LiA.'—r---e-k--6-V---El—D . .
(if known) (7) i / igh 0/0 1-1A-1- Cal 2 2016
Reason for original issue of Warrant/Check (8): 744441c:
MARICOPA COUNTY
E For Services or Goods furnished
O Other:
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schoo)s-Warrants Checks notice of claim,doc
Revised June 2015 A.R.S. 11-632 & 15-999

Maricopa County
Human Resources
(5)
To: Fran McCarroll, Clerk of the Board
From: Wanda Childers
Date: November 30, 2016
Re: Replacement of Lost Payroll Warrants
Please find attached 2 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: 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,
CHERYL L LYMAN (1), being first sworn, upon oath deposes and says:
Name/Claimant
/On or about 09/21/2016 (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 andjherels
no reasonable probability of its being found or presented for payment, or it as
presented for payment within one year after the date of issuance. --z
Therefore, under penalty of perjury, claimant hereby affirms that this claim is'corrkt
and the amount shown is due and owing, and the applicant requests that a repLacenient
warrant/check be issued to him/her in the sum of $ 140.00 ni c—)
C_T1
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 berr_le this 1 / day of
NOTARY PUBLIC
My commission expire: DAWN DAILEY
Notary Public - Arizona 4a1)
.51171 Maricopa County
my L,u111111 Mieb Jc111 L I. I
Warrant/Check Number 22418114
(if known) (6)
Original Date of Issue 09/21/2016
(if known) (7)
Reason for original issue of Warrant/Check (8):
lil Payroll
APii'FICIVIELLD
0 For Services or Goods furnished
DATE1 uhLIQ z
0 Treasurer's refund/payment
0 Other: -
Revised April 2015 A.R.S. 11-632 81. 11-644

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 numbers on the
COUNTY OF MARICOPA Instruction sheet which is page 2 of this form.
JEROME EDWARD JAMES (1), being first sworn, upon oath deposes and says:
Name/Claimant
(60 On or about 09/21/2016 (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 core&
and the amount shown is due and owing, and the applicant requests that a replademeTt
warrant/ched4e issued to hijNher in the sum of $ 130.00
C") • '
Signed: (4) (...n
Note: Please attach a copy of the Itai-t-ant/check if available arid/or any other
evidence that a Warrant/check was origioally issued.
(5) Subscribed and sworn to before me this t2.h, day of OCkitic 20 / 62.
TARY PUBLIC
My commission expires: PATRICIA M. ALLEN
Way/ Pubk-Otate Admit
MY Commission PMRICOPA expires COUNTY May0,2040 (seal)
Warrant/Check Number 22417883
(if known) (6)
Original Date of Issue 09/21/2016
(if known) (7)
Reason for original issue of Warrant/Check (8):
Payroll
C For Services or Goods furnished APPROVED
El Treasurer's refund/payment DAT DEN 2 2016 U-)
LI Other: C)
;7117
(1)
Revised April 2015 A.R.S. 11-632 13t 11-644

MARICOPA COUNTY
Department of Finance
301 West Jefferson, Ste 960
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
C=1",
Date: November 30, 2016
To: Clerk of the Board
From: Beth Brown
Department of Finance
Subject: Affidavit — Replacement of Lost Warrant
Please find attached affidavit for lost warrant to be included on the next available Board
Agenda.
• The attached item has been researched to ensure the warrant in question
has not been cashed or previously re-issued.
• The original warrant has a void/stale date/stop payment done.
Please call me at 506-1329 if you have any questions. Please return the approved
Affidavit to my attention in the Department of Finance, Suite 960.
Thank you.
Re: Silvio Pavlovic

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
page 2 of this form.
Silvio Pavlovic (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 29-Aug -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 .(3)
Signed: (4)
Note: Please attach a com7 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 2( day of N,1:,-,71)1111N: (2- 20 ((>
6n,a)
N ARY PUBLIC WENDI BOLSER
Notary Public - Arizona
My commission expires: Maricopa County
ktb — My Comm. Expires Jun 10, 2018
(seal)
Warrant/Check Number 370003895
(if known) (6)
Original Date of Issue
(if known) (7)
DECNO2 2016
Reason for original issue of Warrant/Check (8):
0 Payroll
111 For Services or Goods furnished
0 Treasurer's refund/payment
Other: Workers Comp TTD 8/15 - 8/28/2016
RECEIVED
NOV 2 1 2016
RISK MANAGEMENT