100516 DUPLICATE WARRANTS 1 - SCHOOLS.PDF

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: 9/14/2016
Please find attached 2 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 602-506-7121 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.
#33 Buckeye El Liv Kari Martinez $766.98
#66 Roosevelt Aikins Distribution $12461.60
AECEIVF
SEP 1 4 2016 . '
MAF;:CO FA COUNTY
CLERK BOARD OF SUPERVISORS
1/0

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.
Martinez, Liv Kari (1), being first sworn, upon oath deposes and says:
Name/Glaimant
On or about September 1, 201 6 (clate)(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 $ 766.98 .(3)
Signed; (4)
(5) Subscribed and sworn to before me this 7-47 day of 20 .
NOTARY PUBLIC
APRIL A. RHODES
Notary Public - Arizona
My commission expires: Marlowe County
Dec-. 3, .,sorg My Comm. Expires Dec 3,2018 (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) 170013236
Original Date of Issue
(if known) (7) 09/01/2016
Reason for original issue of Warrant/Check (8): SERI 9 4116
O Payroll DAT
O For Services or Goods furnished 7;1K EDAFID OF SUP-F_F,A, “.: ,
MARICOPA COUNTY
O 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

VellY
Affidavit
STATE OF ARIZONA )
)ss.
COUNTY OF MARICOPA )
AIKINS DISTRIBUTION INC. being first duly sworn, upon oath deposes and says;
That on the 254h day of AUGUST , 20 16 he presented to the
Roosevelt School District #66 of Maricopa County, for payment, a claim for services
rendered or supplies furnished during the month of AUGUST , said claim
being in the sum of Twelve thousand fonr fiAmtlyed sixt.,-ene v.nd six cents Dollars
($ 12461.60 ) in payment of which the Superintendent of Schools caused his Warrant No.
470011440 to be issued on AUGUST 10 20 16 drawn on the 510
Fund of ROOSEVELT SCHOOL DISTRICT #66 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 of said County issue to him a duplicate of said Warrant No.
470011440 in the sum of $ 12,461.60 .
Title
Subscribed and sworn to before me this
20 kt Q.
My commission expires:U ,093A\-- SHERISE NOTARY PUBLIC K WARSCHER — ARIZONA
MARICOPA COUNTY
My Commission Expires
April 23. 2017

Opul
Aikins Distribution
5707 W Buckeye Rd #D Phoenix, AZ 85043
Office: (602) 442-9394 Fax: (602) 442 -1226 E-Mail: Aikinsdist@cox.net
To Whom It may regard,
My name is Jeremy Aikins. I am the Owner and President of Aikins
Distribution. I am authorized to sign any and all paperwork that comes
thru my company.
I am sorry for all the extra paperwork and time this lost check is
causing everyone. Thank you for all your help in moving this process
along for me.