092116 DUPLICATE WARRANTS - 5.PDF

INTEROFFICE MEMORANDUM
Waricopa County School-Superintendent's 0
TO: CLERX OF TJ-frE 00ARrp
FROM: Willie Thompson
SUBJECT: Affidavits
DATE: 9/6/2016
Zr"
Please find attached,rAffidavitOotice of Craim(s)for Cost warrants for inclusion on
the next avada6re 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 Willie 'Thompson at 506.3898 or via e-mail at
mthompson@mcesa.maricopa. gov. Approved Affidavits ma y be routed back to the
Superintendent of School - "Finance Division at 4041 7V CentralAvenue #1200, ( 12 th
Floor) Thankyou.
#60 .1-fIc LET JO] N- 142 DOLAN . $1726.89
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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.
John W Dolan (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 07/27/2016 (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 amour shown is due and owing, and the applicant requests that a replacement
warrant/check e\issued i to him/her in the sum of $ 1726.89 .(3)
Signed: (4)
(5) Su*ribed and sworn to before me this day of 20
V);:4964C/a40
NOTARY PUBI.
ilfa ft, OFFICIAL SEAL– --- —1
if A, - 1 • TAMMY NAVARRO i
My commission exigi :1)6 Notary Public - State of Arizona ;
07/27/2016 e IVIARICOPA COUNTY I (seal)
I My Comm Expires March 8, 20191
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 170004750/60471723
(if known) (6)
Original Date of Issue 07/27/2016 0
(if known) (7)
Reason for original issue of Warrant/Check (8):
Payroll 1:14
W-417E- of s- 1 MC-7; tsmf s"
El For Services or Goods furnished ° ,npp, cou
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

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.
MELODY ANN STILES (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about (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 su .(3)
n
Signed: (4)
(5) Subscribed aV5)vorn to e this 2ND day of SEPT 20 16 .
My commission expires: MONICA OFFICIAL LOPEZ SEAL r
Notary Public. State ofArizons (seal)
MARICOPA COUNTY
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 i 704.) °y/(07
(if known) (6)
Original Date of Issue
(if known) (7) 7— c. 5 - — 2,3 ) (0
Reason for original issue of Warrant/Check (8):
Payroll
CLERK, - BOARD OF SUPEC/TSORS
El For Services or Goods furnished MARICOPA COUNTY
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