100516 DUPLICATE WARRANTS 4 REDACTED.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: 9/22/2016
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.nnaricopa.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 ActionTec Electronics $15800.00
#79 Litchfield Jessica H'oard $52.53
RECEIVED
SEP 2 2 2016
MAR ICOPA COUNTY
CLERK BOARD OF SUPERVISORS
/(0 114 411

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.
Jessica Hoard (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 07/26/2016 (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/checkilDe issue o him/her in the sum of $ 52.53 .(3)
Signed: (4)
(5) Sut,eribed and s reme this -- A day of 20
VALERIE L PRESTON
NOTARY PUBLIC - ARIZONA
My commission expires: Maricopa County
My Commission Expires (seal)
August 19, 2020
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) 470006738/79706892
Original Date of Issue
(if known) (7) 07/26/2016 . tic IL — Lt% 410 1, V , A4 r.4 _
Reason for original issue of Warrant/Check (8):
D Payroll
Li For Services or Goods furnished
MARICODA
ig Other: Refund for unused lunch money
S: \PROCESSES \Warrants - Duplicate or Stale \02 Forms\Schools \Schools-Warrants Checks notice of claincloc
Revised June 2015 A.R.S. 11-632 & 15-999

,p14
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.
ACTIONTEC ELECTRONICS INC (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about August 18, 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 $ 15,800.00 .( 3)
Signed: (4)
j
(5) Su scribed and sworn to before me this i 3 day of Sepiern ger 6_. 2011
NO - Y PUBLIC
JUDITH BOWLES
Commission *2070358
My commission expires: Notary Public - California /
Jun bi -2Cid Santa Clara County -'(seal)
f,s/1/ Con.Ixfires_Jun 5, 20111;
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 470014678/214731550 A ?PR0 V
(if known) (6)
Original Date of Issue 8/18/16 DATA_T____ SE.12 7 20 16
(if known) (7)
Reason for original issue of Warrant/Check (8):
LI Payroll
El For Services or Goods furnished ScreenBeam Pro Education Edition
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

71ction-ted
_ Creative Solutions for the Digital Life'
9/13/2016
TOLLESON UNION HIGH SCHOOL DISTRICT.
9801 W VAN BUREN STREET
TOLLESON, AZ 85353
Dear Henrietta D. Cooper,
We, Actiontec Electronics Inc., have not received your check number 470014678 for the payment on the
invoice 420359 as you stated that you mail this check 470014678 to us on August 18, 2016.
As a result, I, Irene Chen, controller, authorize Tong Khuc, AR Accountant, to do the affidavit to confirm
that we have not received the check number 470014678 as requested by the customer, Tolleson Union
High School District.
Sincerely,
Irene Chen, Controller.
760 North Mary Ave. • Sunnyvale • CA • 94085 • Tel (408) 752-7700 • Fax (408) 541-9003 www.actiontec.com
NVANMCIII0U16CCOW

INTEROFFICE MEMORANDUM
911aricopa County School-Superintendent's Office
TO: CLERK OE Da W.XXOD
FROM: Willie Thompson
SUBJECT: Affidavits
DATE: 9/22/2016
Please finc f attached 2 AfficiavitObtice of Claim(s)for lost warrants for inclusion on
the ne.v 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 crone.
If you have any questions, please contact Millie (Thompson at 506.3898 or via e-mail at
mthompson@mcesa.maricopa.gov . _Approved_Affidavits may be routed back, to the
Superintendent of School finance Division at 4041 W. Central Avenue #1200, ( 12 th
'Floor) Thankyou.
#5 ISAAC DELIA C RIVERA $1302.07
#59 LAVEEY JESSICA L WE00 $357.61
g-DI :5- it cu,,o tb 730 ON • cl
Cdt,
RECEIVE D
SEP 2 2 2016
CLERK MARICOPA COUNTY
BOARD OF Siti:E:)//COFIS
lo LitenCiA:

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.
D -e e eiver6A_ (1), being first sworn, upon oath deposes and says:
N.1,"'"°c.Ar'rrlarP
On or about q 1 i(p 12,01 Lo (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 $ I 30a .(3)
< (4)
Signed:
(5) Subscri Ele d and sworn to before me this 3(9 411 day of bA20
Lar tekk
NOTAR • BLIC
OFFICIAL SEAL
SANDRA APONTE i
My commision expires: Notary Public- State of Arizona
11V2,0 my MARICOPA Comm ExplresAplii COUNTY 11, 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 /0 603' V/ 7y-
(if (if known) (6)
Date of Issue i / 0 — (1 — ZOIE- nATIA SEF-1 ,7 4
(if known) (7)
Reason for original issue of Warrant/Check (8):
1R4 Payroll
El For Services or Goods furnished
0 Other:
SAOROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc A.R.S. 11-632 & 15-999
Revised June 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.
Jessica L Webb (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about November 5, 2015 (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 $ 357.61 .(3)
(4)
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
(A) Subscrilwd. ahd sworn to before me this 144-k day of3ep-e-17r) beY 201 L.
My commission expires:
Dt-21 -11 3)0/30 (seal)
Warrant/Check Number 160033339
(if known) (6)
Original Date of Issue November 5,2015
(if known) (7)
Reason for original issue of Warrant/Check (8):
0 Payroll
111 For Services or Goods furnished
0 Treasurer's refund/payment
II Other: Repayment of excess State Retirement deducted from last paycheck
SAPROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc
Revised April 2015 A.R.S. 11-632 & 11-644

AFFIDAVIT
APPROVED
STATE OF ARIZONA
COUNTY OF MARICOPA CLERK. BOARD OF SUPERVISORS
MARICOPA COUNTY
da cot:, 13unch , being first duly sworn, upon oath deposes and says:
That on the I of Sepf 20 i to , he presented to 6tACKe_iii Uvitco t.LS 0151-
District of Maricopa County, Arizona, for payment, a claim for services rendered
or supplies furnished during the
month of AU5u54- 201C0 , said claim being in the sum of
kundre8-1-Wtokj Y6 5 —Dollars, ($ (9 ) in payment of which the
Superintendent of Schools caused his/her Warrant Number 201(o ILD 430 to be
issued on Seple,yaeAf I 20 lb , drawn on the Col Fund of Burkelit, Union
District of Maricopa County, Arizona.
Affiant further says that although he/she 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/her a duplicate of said Warrant Number
201(olto 430 in the sum of $620. Icl .
BEVERLY J. JOHNSON
Notary Public - Arizona
Signed: Maricopa County
My Comm. Expires Jul 24, 2019
Subscribed and sworn to before me this day of r,20
NOTARY PUBLIC
My commission expires:
Following approval p1696e retg this affidavit to the Maricopa County School Superintendents Office.

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: 9/26/2016
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.
#17 Tolleson El Compass Group USA $72378.61
#17 Tolleson El Compass Group USA $39464.02
VED
2016
MARGCR COUNTY
CLERK BOARD OF SUPERVISORS
—r tki\c:i\

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.
Compass Group USA Inc. (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 08/24/2016 (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 issued to him/her in the sum of $ 72378.61 , .( 3 )
Signed: (4)
(5) Subscribed and sworn to before me this f:242 tv._4±day of (2O I4 .
mi&w L_Afff.L;
NOTARY PUBLIC
ISABEL DEL TORO
Notary Public - Arizona
My commission expires: Maricopa County
Fel) .9J7) c2E. My Comm. Expires Feb 27, 2020 (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 470015465
(if known) (6)
Original (if Date known) of (7) Issue 08/24/2016 A P P Nj V E L
Reason for original issue of Warrant/Check (8):
0 Payroll CLERK. BOARD OFSUPERVISORS,
• For Services or Goods furnished
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

chartwells
eat. learn. live.
September 22, 2016,
To whom it may concern,
This letter is to inform you that our employee Ivy Kusler District Manager for Arizona is an authorized
representative of Compass Group USA Inc. She has permissions to be the authorized signer for your
enclosed Affidavit/Claim Form regarding our request for a duplicate check/warrant for the following
invoices and amounts, which you had issued to us but was never received.
Invoice # X291211016 in the amount of 72,378.61
We need this payment re-issued to us as soon as possible as this payment is extremely past due.
Th(nk you,
. Moll
RVP, West Region
22121 17th Avenue SE. #E227 Bothell, WA 98021
Phone: 425-827-1200 Fax: 425-827-1220

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.
Compass Group USA Inc. (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 08/29/2016 (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 issued to him/her in the sum of $ 39,464.02 .(3)
Signed: (4)
(5) Subscribed and sworn to before me thisoP.itg day of
LIJ DiudbribiabillbmarramIlls.4
NOTARY PUBLIC ISABEL DEL TORO
Notary Public - Arizona
Maricopa County
My commission expires: My Comm. Expires Feb 27, 2020
Fel)1 lq) go cti) (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 470017565
(if known) (6)
Original Date of Issue 08/29/2016 , 7.7 r
(if known) (7)
Reason for original issue of Warrant/Check (8):
111 Payroll
._,OARD OF SUPERVISORS
11 For Services or Goods furnished MARICOPA COUNTY
CI 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

(ive ci4
chartwells
eat. learn. live.
September 22, 2016,
To whom it may concern,
This letter is to inform you that our employee Ivy Kusler District Manager for Arizona is an authorized
representative of Compass Group USA Inc. She has permissions to be the authorized signer for your
enclosed Affidavit/Claim Form regarding our request for a duplicate check/warrant for the following
invoices and amounts, which you had issued to us but was never received.
Invoice# X291210916 in the amount of 32,434.60
Invoice #2912100008 in the amount of 7,029.42
We need this payment re-issued to us as soon as possible as this payment is extremely past due.
Thafik you,
M. Moll
RVP, West Region
22121 17th Avenue SE. #E227 Bothell, WA 98021
Phone: 425-827-1200 Fax: 425-827-1220

INTEROFFICE MEMORANDUM
Waricopa County School -Superintendent's 0
TO: CLERX OE VIE W.AW9)
FROM: Wirrie 'Thompson
SUBJECT: Affidavits
DATE: 9/27/2016
Please _find attached 1 Affidavit/Wotice of Claim(s)for lost warrants for inclusion on
the nek-t availaffe Woard agenda
The attached item(s) have heen 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 Millie 'Thompson at 506.3898 or via e-mail at
mthompson@mcesa.maricopa.gov. :Approved Affidavits may 6e routed hack to the
Superintendent of School finance Division at 4041 X Central -Avenue #1200, ( 12 th
'Floor) Thankyou.
#45 'FOWL Elizabeth m WIcquiston $136.49
RECEIVED
SEP 2 7 2016
MAR ICOPA COUNTY
CLERK BOARD OF SUPERVISORS

Application for a Duplicate or Stale-Dated Warrant/Check
446
Affidavit/k' 1t:: Form
This application is for: gl 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.
MC QUISTON, ELIZABETH MARY (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 9/9/2016 (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, m. 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 $ 136.49 .(3)
rn
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 ns day of lap-\ert.,,k.f2,-- 20 N .
NOTARY PUBLIC
Notary EDITH Public DUARTE - Arizona
My commission expires: My Commission Marloops County Expires
December 13, 201a (seal)
Warrant/Check Number 45219598
(if known) (6)
Original Date of Issue 9/9/2016
(if known) (7) VED
APk!KO
Reason for original issue of Warrant/Check (8): 2 8 2016
Payroll
111 For Services or Goods furnished
ID Treasurer's refund/payment
El Other:
S: \PROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc
Revised April 2015 A.R.S. 11-632 & 11-644