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Memo OCT J Mro mAH! To: Fran McCarroll, Clerk of the Board CLERK VISORS ib From: Linda Widner Date: October 10, 2016 Re: Replacement of Lost Payroll Warrants Please find attached 1 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 Linda W. at ext. 68051 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: [0 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. Name/029 Cannay (1), being first sworn, upon oath deposes and says: On or about Cdobrycii,zona (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 -7q7 warrant/checklbe issue,c1 (:,- h/herp the sum of $ .(3) 4 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. rn to befor.etritnieill-ili i I U. day of OUtOlige,\( 20j, Q . . KiN 1/, e, • .... .......... .1.43 1.) z My_cqmmission QXpires: "Jr' I ola frfri (//c,20/ ':••I••• (seal) ......... 1),C\,I.% \$. f„ N Ty Warrant/Check Number (if known) (6) Original Date of Issue (if known) (7) Reas9'n for original issue of Warrant/Check (8): ve Payroll El For Services or Goods furnished El Treasurer's refund/payment CI Other: Revised April 2015 A.R.S. 11-632 ,131, 11-644 cash eChedc bUQU8 tAos yent my cid 10(ation 60)01 7--cs uqi recine Maria Ceaglske - COBX From: Linda Widner - HRX Sent: Wednesday, October 12, 2016 7:11 AM To: Maria Ceaglske - COBX Subject: RE: Arianna Cannady Duplicate Warrant Request Good morning Maria! I am so sorry it wasn't on the form. The check number is 22424352 and it was issued on 10/5/2016. Thanks, Linda Linda Widner Payroll Specialist Maricopa County Human Resources — "Your Partner for Success" Iwidner@mail.maricopa.gov Tel: 602.506.8051 Fax: 602.372.8722 http://www.maricopa.govihuman resources/ 301 W. Jefferson, Phoenix, AZ 85003 From: Maria Ceaglske - COBX Sent: Tuesday, October 11, 2016 3:35 PM To: Linda Widner - HRX Subject: Arianna Cannady Duplicate Warrant Request Ms. Widner, Our office received the attached duplicate warrant request but there is no warrant/check number written on the form. If you can get back to me by tomorrow afternoon I can still get the request on the October 19, 2016 agenda for Board of Supervisor action. Thank you, Maria Ceagiske Maricopa County — Office of the Clerk of the Board of Supervisors 301 W. Jefferson Street, 10th Floor, Phoenix, AZ 85003 Phone: 602-506-3766 Email: ceaglskem@mail.maricopa.gov 1 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: 10/11/2016 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.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. #9 Wicken burg Vivian C Carson $66.57 DC 2016 rY OF SUPERVISORS ose- WICKENBURG UNIFIED SCHOOL DISTRICT NO. 9 40 W. Yavapai, Wickenburg AZ 85390 Phone (928) 668-5350 Fax (928) 668-5390 cmAmp„,N, - CHILDREN FOR - AFFIDAVIT vian C.. Ca rstin , being first duly sworn, upon oath deposes and says: That on the day of Se-P*• 20l, he presented to Wickenburg Unified School District #9 Maricopa County, for payment, a claim for services rendered or supplies furnished during the month of Llem said claim being the sum of 5 l)(41J-3kx do (lays 4- 57/ tr0 Dollars ($ (a,. 5 7 ) in payment of which the Superintendent of Schools caused Warrant # 'tlOOl qlso to be issued on 5ep4•. , 20 /(t, , drawn on the 001 fund of Wickenburg Unified School District #9 of Maricopa County, Arizona. Affiant further says that although he was informed and believes that the above mentioned warrant was regularly issued, the same has never been received, or has been lost. Wherefore, affiant prays that the Board of Supervisors order and the Superintendent of schools issue to him a duplicate of said Warrant #4106 i C175bin the sum of $ 14,4) S- 7 . Signature: Subscribed and sworn before me this Slit day of , 20 /6 . SANDRA G,KIWEGER . NOUN PUNIC. AMOK% .toilammamenv 11- oil Co mission Expiration Date Q3044/4 APPROVED 00111 2o, DA Following Notary approval please return original affidavit to: Wickenburg Unified School District CLERK. BOARD OF SUPERVISORS Accounts Payable MARICOPA COUNTY 40 W. Yavapai Street Wickenburg, AZ 85390 INTEROFFICE MEMORANDUM 911aricopa County School-Superintendent's Office TO: CLERX TJCE 00.ARD FROM: Willie Thompson SUBJECT: Affidavits DATE: 10/10/2016 Please find attached 1 Affidavit/g\ro lice of Claim(s)for Cost warrants for inclusion on the ne,ct available Ooard 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. If you have any questions, please contact Wiffie Thompson at 372-1244 or via e-mail 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 'Floor) 'Than/you. #216 AGO EWA ALEXIS RODRIGVEZ $63.88 OCT ?MI6 MARICO PA GO CLERK BOARD OF SUPERVISORS 2(6 6 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. (eX d EZ (1), being first sworn, upon oath deposes and says: Name/Claimant On or about Ci —((o (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 $ (63 -?9' .(3) Signed: (4) (5) Subscribed and sworn to before me this 6-1-4 day of or-mber 20 / 4i• Ii i NOTARY PUBLIC .- - toFF rF I I L./cL COLETTE HAYES : My commission expires: Notery Public - State of Arizona! MARICOPA COUNTY i /0-15- / 9 My Comm. Expires Oct. 15, 2019 (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 1700 ra -yaq (if known) (6) Original Date of Issue aa —(c.p (if known) (7) q — i A To 12 II 0 V E Reason for original issue of Warrant/Check (8): DAT 0C11 12(116 IX Payroll 0 For Services or Goods furnished ERIK : mapicopA BOARD OF COUNTY SUPERVISORS 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