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INTEROFFICE MEMORANDUM llaricopa County School-Superintendent's Office TO: CLERK, OE TOE WARD FROM: Willie Thompson SUBJECT: Affidavits DATE: 11/2/2016 Prease find attached 1 Affidavit/Yotice of Cfaim(s)for Cost 'warrants for incrusion on the ne4 avadaffe Ooard agenda The attached item(s) have 6een researched to ensure that the warrant(s) in question have not deen cashed or previousCy re-issued: The original-warrant(s) have had a stop payment done. If you have any questions, p&ise 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 X. Central- Avenue #1200, ( 12 th (Floor) Thankyou. #65 LITTLETON - ELEgli WASSP $139.40 BON' A, Stop Payment 1, n '4'frsci40° Affidavit Business Resources STATE OF ARIZONA DATA NA0 4 75 COUNTY OF MARICOPA ERK BOARD OF SUPERVISORS MARICOPA COUNTY National Association of Secondary School Principals , being first duly sworn, upon oath deposes and states: That on the 19 day of April , 20 16 , he/she presented to Littleton Elementary School District No. 65, of Maricopa County, for payment, a claim for services rendered or supplies furnished during the month of April , said claim being in the sum of One hundred thirty-nine dollars .40 Dollars ($ 139.40 ) in payment of which Littleton Elementary School District No. 65 caused warrant/check number 460095644 to be issued on 25 day of April ,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 number46009544 in the sum of $ 139.40 Signature Subscribed and sworn before me this day ofraber- , 20 /t . Signatur,e of No,tary Publi ,,,,,,,,,,,, \-‘• L , , My Commission Expires NpOuTBALR1 .• ,,,,,, oY • xi. S72 Coun17 : ci") REG # 254513 MY COMMISSION E8/X3P1112R0E1S8 ...... ,,,,,, LaTo 03/2013 NASSP #11 National Association of Secondary School Principals October 27, 2016 Dear Sir or Madam: This is to certify that Minna Cavanaugh, as Accounts Receivable Manager, is authorized to sign off on Stop Payment Affidavits. Sincerely, Mike Shifflett CFO 1904 Association Drive, Reston, VA 20292-2537 P 703.860.0200 F 703.476 .5432 www.nassp.org 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: 11/1/2016 Please find attached 3 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 Angela Ortiz $415.13 #65 Littleton Southwest Academy $26751.60 #25 Liberty Debra Walker-Post Net $8.43 NO V 2 0 15 CLE1 49\4 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. Dr-17.2_ Ijitalf1gitant (1), being first sworn, upon oath deposes and says: On or about 67 ( / (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 hip-Mer in the sum of $ q/c. / 3 .(3) Signed: CZ (4) (5) Subperibed and sworn to before me this _,%PtClay of &wig+) 20 n . L ble4ke NOTA K JOYCE C. COUNCIL 4 pssion expires: Notary Public-State of Arizona MARICOPA COUNl( COMMISSIOn Expires Sept 11, 2017 eal) 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) /1001111.41 Original Date of Issue f He (if known) (7) q I he . •,,,. VS VW Ai tr W. ni 1.1 r r AA °I.' Reasorj_for original issue of Warrant/Check (8): NtPayroll 0 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 Stop Payment en , ASAILA Ek k Affidavit Business Resources APPROVED STATE OF ARIZONA DATA ND "i4iQ COUNTY OF MARICOPA RK, BOARD OF SUPERVISORS MARICOPA COUNTS' Southwest Academy , being first duly sworn, upon oath deposes and states: That on the 31 day of August , 20 16 , he/she presented to Littleton Elementar y School District No. 65, of Maricopa Count y, for payment, a claim for services rendered or supplies furnished durin g the month of Au g ust , said claim being in the sum of TWayrty six. Aailsitild alien hvraTel -4-ly brie Dollars ($ 26,751.60 ) in payment of which Littleton Elementar y School District No. 65 caused warrant/check number 470020897 to be issued on 8 day of September , 20 16 drawn on the warrant/check fund of Littleton Elementar y School District No. 65 of Maricopa County, Arizona. Affiant further states that althou gh 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 re quests that the Governin g Board order and the Littleton Elementar y School District No. 65 issue to him/her a replacement of said warrant/check number 470020897 in the sum of $ 26,751.60 Signature Subscribed and sworn before me this i t day of odtipeA-7 , 20 ) . Signature of of Notary Public DONNA RAYYAN NOTARY PUBUO - ARIZONA Mancopa County My CommItaton EXpirOP June 21, MO My Commission Expires 03/2013 SOUTHWEST ACADEMY 26 October 2016 Dear Ms. Logue and Ms. Weihe: Kathy Burwell is authorized to sign the stop payment affidavit on behalf of Special Education Services DBA Southwest Academy. Sincerely, Brian McGowan CFO Special Education Services The Menta Group Special Education Services • An Affiliate of The Menta Group® 4018 N. 67 Ave • Phoenix Arizona 85033 • (623) 849-8511 • Fax (480) 454-8750 wvvvv.tliementagrotap.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 MAR ICOPA Instruction sheet which is page 2 of this form. Ri.a.Laer /Lki- (1), being first sworn, upon oath deposes and says: ame/Claimanti On or about 910/16 (clate)(2) a warrant/check was issued to the above named peilson/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 a 9 warrant/check be issued to him/her in the sum of $ o. -(3) Signed: ,014 Paib, (4) (5) Subscribed and sworn to before me this r day of e967- 20 / . NOTARY PUBLIC < OFFICIAL SEAL My commission expires: KATHERINE M WILLEY Notary Pubic- State ot Arizona MARICOPA COUNTY (seal) My Comm. Expires March 11, 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 ols3-61 'WV 11 ? 00di cie7 (if known) (6) Original Date of Issue (if known) (7) Reason for original issue of Warrant/Check (8): 0 Payroll tRK: BOARD D r Rut For Services or Goods furnished t/11/0 1 (-2, MARCOPA COUNTY 0 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 October 21, 2016 To Whom It May Concern: I, Debra Walker, am the owner and authorized signer for the company of DDWalker Enterprises Inc. dba PostNet AZ138. Please let me know if you required any additional information. Sincerely, Debra Walker PostNet AZ138 1300 S. Watson Rd. Buckeye, AZ 85326 1300 S. Watson Rd. A-114 Tel (623) 691 -6544 Buckeye, AZ 85326 Fax (623) 474 - 6032 www.postnet.com/az138 az138@postnet.com