090716 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: 8/2/2016
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.
#214 Tolleson Union Inventive Technologies $11916.15
#5 Isaac Cruz & Assoc. Consulting $5500.00
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. BOARD OF . ..'NVISORS
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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.
Teebnolo,Sle (1), being first sworn, upon oath deposes and says:
Name/C aimant
On or about June 23, 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 issuedirrhtm/her in the sum of $ 11,916.15 .(3)
Signed: (4)
(5) Subscribed and sworn to before me this g5 day of —c-S-.AVi 20_,r .
NOTARY PUBLIC
Diane Hamilton
My commission expires: Notary Public
State of Colorado
it/ lec I ea-Oli My Commission Expries 11119/2017 (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 460115498/214730463
(if known) (6)
Original Date of Issue 6/23/1 6
(if known) (7)
Reason for original issue of Warrant/Check (8):
Eli Payroll
For Services or Goods furnished
111 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

by Inventive Technology
Tolleson High School
ATTN: Henrietta Cooper
July 25, 2016
To whom it may concern;
Terry Kennedy is the President of Inventive Technology, Inc. He is authorized to sign any documents for
Inventive Technology, Inc.
Sincerely,
Diane Hamilton
Accounting/Office Manager
Inventive Technology, Inc. 9056 Marshall Court Westminster, CO 80031 800 474-5128 info@inventivetec.com

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.
(bps u (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about Kim (.( )_0((p (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/ch-a-St be i5sped to him/her in the sum of $ 5 6-00, 00 .(3)
Signed: (4)
(5) Subscribed and sworn to before me this 611/4141‘ v day of 'Jai 20 1 Ce
IA .
NOTARY PUBLIC
MARIA ORDONEZ
My commission expires: :1"A 1 Notary Public, State of Texas
My t ornmisslon Expires
tr4-1 Zol July 14, 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
(if known) (6) 4{0-01 Ono n ; T. AUG 5 2016
Original Date of Issue
(if known) (7) kftf 06p
Reason for original issue of Warrant/Check (8):
El Payroll
VI For Services or Goods furnished P(04'esS °via Sev0i'e4s
El Other:
SAPROCESSESMarrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claindoc
Revised June 2015 A.R.S. 11-632 & 15-999

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