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MARICOPA COUNTY Department of Finance 301 West Jefferson, Ste 960 Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM Date: October 26, 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: ANA CASATNEDA RE OLT ; ?016 MAH CLERK BOARD 0; RV1SO RS iiD 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. Karla Geronimo Sepulveda (1), being first sworn, upon oath deposes and says: Name/Claimant On or about f (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 $ 153 .32 .(3) Signed: (4) (5) Subs rbed a o efore me this 1--11.-V\ day of P fz,i9e< 20 /(o . NOTARY IC OFFICIAL SEAL 40-r-Fli, CHERYL CARDER My corn issi.n expires: 0 MARICOPA COUNTY Alton :• 1 • •.0( . :............•........•......•............ 'Alirrivb‘ MyCormExpireakm.12 .. ' 2017 .. : I (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 - 7 - 00 I gq 5C) (if known) (6) Original Date of Issue 09/22/2016 1 (if known) (7) APPROVED Reason for original issue of Warrant/Check (8): DA 714 4' • Payroll LERK. BOARD OF SUPERVISORS • For Services or Goods furnished MARICOPA COUNTY E 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 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 paae 2 of this form. Ana Castaneda (I), being first sworn, upon oath deposes and says: Name/clamant On or about 16-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 $ 131.76 -(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) Subscribed and sworn to before me this day of c_A-ckyi-r 20 . %— - NOTARY PUBLIC BECKY VALDEZ My commission expires: COPA Arizona A OZ. Q4j, Eirs (seal) Warrant/Check Number 370002902 (if known) (6) Original Date of Issue 16-Aug-2016 (if known) (7) kr 11.11 .u).• Reason for original issue of Warrant/Check (8): CI Payroll 0 For Services or Goods furnished 0 Treasurer's refund/payment Other: VICTIM CLAIM INTEROFFICE MEMORANDUM Ilaricopa County School" Superintendent's Office TO: CLERK,OE (Da 004RD FROM: Willie (Thompson SUBJECT: Affidavits DATE: 10/26/2016 Pase find attached 2 Affidavit/Arotice of Craim(s)for Cost warrants for inclusion on the net avada6Th Ooard agenda -\1 The attached item(s) have 6een 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 Willie Thompson at 372-1244 or via e-mail at mthompson@mcesa.maricopa.gov . Approved Affidavits may be routed 6cIck, to the Superintendent of School nuance Division at 4041 N: Central. Avenue #1200, ( 12 th Eloor) Thankyou. #5 ISAAC ELE511 JEAVE(1 1113R.3514ILLO $694.24 #68 AL.1 -0.41R.3 KARLA GERO1 -19140 SEP7.)LVEDA $153.32 OCT 2 CLERK BOARL, 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. 'ce-4 PLI--0 .6A r& (1), being first sworn, upon oath deposes and says: Na &Claimant On or about /0 14 0/ 0 (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 su of $ 6ge./,V .(3) Signed; 4-eRk4 (4) (5) Subscri and sworn to before me this day of c_4-e_i7 20 ite . at-tv(At 61: NOTARY PUBLIC : /1-Tre, 6 OFFICIAL SEAL . SANDRA APONTE My comm I ssioni expires: Mfty12tiblio MARICOPA - State COUNTY of Mona 1.1 i 1 i d,f)d,o , ..111•10.1111MMIIIIIMM101111.101.1.101111 ‘TieFi'3 My Comm. Expires 1=• 11 0•11111111•11111 Arg 11, • 11.11MMIRI 2020 I (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 7 (if known) (6) j Original Date of Issue (if known) (7) / Rea.s9rifor original issue of Warrant/Check (8): ar2(1.40 Payroll DATE 0 For Services or Goods furnished --AEU Mir a P •V SORS MARIGOPA COUNTY 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