092116 DUPLICATE WARRANTS - 3.PDF

INTEROFFICE MEMORANDUM
-
Waricopa County School-Superintendent's Office
TO: CLERX0E DIE WOARD SLP 09 2015
FROM: Willie Thompson
SUBJECT: Affidavits CLERK BOARD OF I iVI
DATE: 9/9/2016
Pase find attached 1 AffidavitObtice of Cfaim(s)for lost warrants for inclusion on
the next availaffe Ooard agenda
The attached item(s) have 6een researched to ensure that the warrant(s) in
question have not 6een cashed or previously re-thsued
The original-warrant(s) have had a stop payment done.
If you have any questions, please contact Willie Thompson at 506.3898 or via e-mad at
mthompson@mcesa.maricopa.gov . Approved Affidavits may 6e routed back to the
Superintendent of School finance Division at 4041 .1V: CentrafAvenue #1200, ( 12 th
Floor) Thankyou.
#62 VW:10X ZE10 JOIVE $957.06

1)-0.0Y
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
C UNTY OF MARICOPA Instruction sheet which is page 2 of this form.
410 (11cc- (1), being first sworn, upon oath deposes and says:
ame/ aimant
On or about A5 12o (co (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/cheick be issue to him/her, in the sum of $ q57 .0(c, .(3)
(4)
HiJ1,591111 r4d rrooirii to before me this 1.1-\ day of ji40-1 20 /(0 .
OFFICIAL SEAL
DOLORES M. VILLAWEVA
Notary Public - State of Arizona
My commission expires: MARICOPA COUNTY
30 1.....•• I...I••I••I iø My Corn. ••I ••I Expires ••I ••I AprIl ••I• 30,2019 II ••I•• 1 (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) II 00 ) 1 753
Original Date of Issue gia 1 .z oiu
(if known) (7)
Reasop for original issue of Warrant/Check (8):
'V Payroll
El For Services or Goods furnished
MARICOPA COUNTY
CI Other:
SAPROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc
Revised June 2015 A.R.S. 11-632 & 15-999