092116 DUPLICATE WARRANTS - 2.PDF

Maricopa County
Human Resources
Memo
To: Fran McCarroll, Clerk of the Board C, c,3
From: Debbie Upton
Date: August 31, 2016
Re: Replacement of Lost Payroll Warrants
Please find attached 'I 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 Debbie U. at ext. 66329 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 0212512015

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.
(1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about A'Itycl 2-t,f, 701 b (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 arg thew is
no reasonable probability of its being found or presented for payment, or itwaOot
presented for payment within one year after the date of issuance.
Therefore, under penalty of perjury, claimant hereby affirms that this claim'J coTrect
and the amount shown is due and owing, and the applicant requests that a reOacement
0, 0
warrant/check bp issueto %., him/her in the sum of $
Cl)
Signed: AL, LI, 'K,ALANAL (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 30 day of
NOTARY PUBLIC
L. GUINN
Notary Public- State of Arizona
My,commission expires: MARICOPA COUNTY
My Commission Expires ,
f t) November 1, 2018 (5
Warrant/Check Number 00
(if known) (6) -2i ?g g
Original Date of Issue
(if known) (7) g/2_1,(1Z01 4,
Reason for original issue of Warrant/Check (8):
Payroll
El For Services or Goods furnished
El Treasurer's refund/payment
CI Other:
CAUsers\williamse\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\HTTDL74G\Warrants Checks notice
of claim.doc
Revised April 2015 A.R.S. 11-632 81.11-644
te2 secUvq-kii-K re ady
Co 0 0 3 - L-) 2

Tubbe,Jacob Ryan Company, MCI Off Cycle: N
MC1 - Maricopa County Pay Group: NEX Separate Check # 0
Period End 08/14/2016 Reprint: N
Page 981 Adjustment: N
Active 12/20/2010 Reg/FT Line: 7
- Tubbe,Jacob Ryan - MCVNEX
\,/ le ,,,, MCY-Earnings Taxes Deductions Garnishments Special Accumulators Distributions
------ 1
Name Tubbe,Jacob Ryan Confirmed Check
Checkt issue Date Earninas Taxes Deductions Net Pay
22409896 08/24/2016 769.69 1
..
._ ..,
ADP Enterprise HR screen print as of: 08/31/2016 09:24 AM

INTEROFFICE MEMORANDUM
5frfaricopa County Scfioor Superintendent's Office
TO: CLERK OF TOE 00AR9)
FROM: %Lillie 'Thompson
SUBJECT: Affidavits
DATE: 9/1/2016
Pase find attached 2 Afficiavit/Arotice of Craim(s)for Cost warrants for incrusion on
the nek-t avadaffe Ooard agenda
The attached item(s) have been researched to ensure that the warrant(s) in
question have not been cashed or previous()) re-issued:
The original. warrant (s) have had a stop payment done.
If you have any questions, ',Cease contact Willie Thompson at 506.3898 or via e-mad at
mthompson@mcesa.maricopa.gov . Approved Affidavits may be routed back to the
Superintendent of School finance Division at 4041 N. Central - Avenue #1200, ( 12 th
Efoor) Thankyou.
#60 .7fIGLET NAVE DALET $385.42
#98 EOVNTAI9V1TILLS C17-QI,S'TIYA PRICE $1086.90
RECEIVED
SEP 01 2016
KAH:- :OPA COUNTY
CLERK ElOAI'D OF SUPERVISORS

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.
(Art:Sil'Az) (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about OP/42 °I6 (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/gbeck be issup..c10 him/her in the sum of $ 0 67‘.r .(3)
Signed: (4)
(5) Subscribed and sworn to before me this 03 day of AucsuS 31- o _
Denisse Lopez
Notary Public
My commission expires: Maricopa County, Arizona
7_oci My Comm. Expires 11-8-2019 (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 / 3;6'04 K //7000q,3[,-1
(if known) (6)
Original Date of Issue
(if known) (7)
Reaso9,,for original issue of Warrant/Check (8):
2' Payroll
El For Services or Goods furnished
El 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

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: 9/1/2016
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 602-506-7121 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.
#90 Saddle Mtn Jeff Wahlert/Acorn Propane $1097.33
#1 Phoenix El Whole Armor Performance Gear $295.50
#95 Queen Creek Loseph Lombardo/Learning Seed $1398.13
RECEIVED
SEP 01 2016
MARK:OF/2; COUNTY
CLERK BOARD OF SUPERVISORS
ctSe

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.
Wejl)tr)-- "—(1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about hc-s1 3.-‘, (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/died be issued to him/her in the sum of $ i „3 .(3)
V Signed: (ALLp (4)
,S. ) Subscribed and sworn to before me this D—)-44•-day of 20 .
/i dIkAc12%1
ALEXANDRA GARCIA
Notary Public - Arizona
Maricopa County
My commission expires: r 7 My Comm. Expires Jun 3, 2019
!"',ZPNV-M4T-'W''''7,1"2110mr,VP",V.P"VP",15.°C7'1/47 (seal) r
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 c fzi'5;3S.31— L(10 1 -
(if known) (6) \9 1
Original Date of Issue 51,5),Ii,k
(if known) (7)
Reason for original issue of Warrant/Check (8):
O Payroll
114'or Services or Goods furnished
El Other:
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc A.R.S. 11-632 & 15-999
Revised June 2015

ACORN GAS COMPANY
908 S. 27th AVE.
CORM' PHOENIX, AZ 85009
nip piaptf r Ph: 602-437-4660
Fax: 602-278-2887
07/20/2016
RE: Company Signature Authorization
Dear SMUSD,
The individual below is authorized to sign for all matters relating to Acorn Propane.
Attached is a notarized application for a duplicate check request. Please call
our office with any questions.
Name: Jeff Wahlert Signature: (LA...Li— Title:Operations Mgr.

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.
Whole Armor Performance Gear (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 05/26/2016 (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/check be issued to him/her in the sum of $ 295 .50
Signed: (4)
(5) Subscribed an t worn IA* to before me this day of Z._.)1_4 201
a. taiL.
pOTARY PUBLIC
My commission expires: Notary ANA Public E. - MOLINA State of Atizona
e6 I MARICOPA COUNTY
My Commission Expires (seal)
January 22, 2017
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was onginally issued.
Warrant/Check Number 4460105952
(if known) (6)
Original Date of Issue 05/26/2016
(if known) (7)
Reason for original issue of Warrant/Check (8):
0 Payroll
ET For Services or Goods furnished
111 Other:
Revised S:\PROCESSES\Warrants June 2015 - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc
A.R.S. 11-632 & 15-999

(619)354-9517 WHOLE ARMOR 611
Vo I ll \ SALES@WA611.COM COMMITTED TO NICH QuAL;TI. siva. COMFOOiECEVED
http: //www.wa611.com AUG 1 1 2016
ACCTS. PAYABLE
To Whom it may Concern,
Please accept this as authorization for Elsa Balderas, Managing Member of Whole
Armor, to sign on behalf of Whole Armor LLC.
This meets the requirements requested by Phoenix Elementary School District #1
Attn: Rosalind Roberson.
Thank you for your business,
Ramon Madrid
Whole Armor Managing Member
ramon@wa611.com
Wholearmor611@gmail.com

ide4-- 40 OJ-
AFFIDAVIT
lady Ieosed.c0
STATE OF ARIZONA sS'2.1(cm
COUNTY OF MARICOPA
I CLERK. BOARD OF COUNTY SUPERVISORS
30$ h UTYWAY80 being first duly sworn, upon oath deposes-and says:
rm r1,3
That on the ..1.-..\*11.) .. day of ...aa-r , 20 t LC' , he presented to
Ut'b of Maricopa County, for payment, a claim for
services rendered or supplies furnished during the month of .nurcet. , said claim
being in the sum of-TM:kretv3.1wackiceil 4.10.v.N.1416.ei..4\4- a/1013 dollars
($.1.(Ne4 • . ) in payment of which GO..tev%
caused Warrant No. (C)CID 121 to be issued on k1;t1 1 , 20 IC4
drawn on the t:v-k- fund of avee-r) ex' 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
\u.,evN aceS1.-) issue to him a duplicate of said Warrant No.
14900q Ck in the sum of t1.5C1
KATHLEEN F. CRAIG
Notary OFFICIAL Public, State SEAL of Illinois
My Commission Expires
January 09, 2017
Subscribed d swombefore me this /3 k day of 0 ,
Notary Public
My Commission Expires
-.CC-1—.7.a a- L. 1, --a-. -I- - -1.. nett__