090716 DUPLICATE WARRANTS 2 - SCHOOLS_REDACTED.PDF

INTEROFFICE MEMORANDUM
Waricopa County School -Superintendent's Office
TO: CLERX OE TOE 00ARD
FROM: Willie (Thompson
SUBJECT: Affidavits
DATE: 8/4/2016
Tase find attached 3 AffidavittArotice of Cfaim(s)for Cost warrants for indusion on
the next avaiCa6 Ooard agenda
The attached item(s) have 6een researched to ensure that the warrant(s) in
question have not 6een cashed or previousCy re-issued
The original- warrant (s) have had a stop payment done.
If you have any questions, prease contact Mae 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 W. Central- Avenue #1200, ( 12 th
ECoor) Thankyou.
#8 OSOOW LVSKAX (YA ECOEVERRIA $1407.87
#215W -OW-ff DEOWE CARRILLO $934.68
#214 TOLLESON 'ONION - JACOO WANWAY -f $189.51
RECEIVED
AUG 5 2016
MARICOPA cowry
CLERK BOARD OF SUPLAVISORS
thytiu.t

AFFIDAVIT
STATE OF ARIZONA
COUNTY OF MARICOPA
1..-QS\navvk A Ellne VC 116 0., being first duly sworn, upon oath deposes and says:
That on the 361 day of 20 , he presented to D,S13,tyin ScPtcy) i
District of Maricopa County, Arizona, for payment, a claim for services rendered
or supplies furnished during the
month of iipne_ 20 L (.0, said claim being in the sum of
(gdo- = j.3.2) in payment of which the
1,-)Lryikceei 00,0( \)eh do\ .01.1ri Si
Superintendent of Schools caused his/her Warrant Number 1cy9 Z'S-.S to be
issued on ...)vn t , 201 (09 , drawn on the 30 Fund of OS boY h SCA.1.0\ s-$1"
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
\ U001 2 (p-SS in the sum of $ I L.O71g7
Signed: V.tak-OUtLICU (( AJCI)
Subscribed and sworn to before me this \___/ day o ,20
VALERIE Coonty Notary of C ANDERSEN Nubile Markopa
MyComollsalon Coma AugustiS taloa 0310722 2011 Expites
NOTARY PUBLIC
My commission expires: 6-4 „AN?
Following approval please return this affidavit to the Maricopa County School Superintendents Office.

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.
Debbie Carrillo (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 77A0/cfc9/6 (date)(2) a warrant/check was issued to the
above named perso /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 $ 934.68 .(3)
Signed: (4)
nd 5.worn to before me this / - day o 20
ARY PUBLIC OFFICIAL SEAL
BARBARA GRACIA j
Notety p - State of Arizona
;14cvozmis,sion expires: \ MARICOPACOUNlY :
// c:70W My Comm. Expires Sept. 16.2016! (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 170001299
(if known) (6)
Original Date of Issue 07/14/2016
(if known) (7)
Reason for original issue of Warrant/Check (8):
Payroll
0 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

AFFIDAVIT
STATE OF ARIZONA
COUNTY OF MARICOPA
SOCl/0 i4COVICLA , being first duly sworn, upon oath deposes and says:
That on the A; day of-) 2011e , he presented to / Dite,,s(41 Linton
District of Maricopa County, Arizona, for payment, a claim for services rendered
or supplies furnished during the
month of 20 /49 said claim being in the sum of
60,-.4e A Pi.- Dor IA) ars, ($ Ig 4)*S1 ) in payment of which the
Superintendent of Schools caused his/her Warrant Number /11003 4,3 to be
issued on a2- , 20 fie, drawn on the Pa Fund of VaarM //AWN 171S •
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
17001)5b5 in the sum of $ /*SI.
Subscribed and sworn to before me this 7L_ day of ,20
JOYCE C. COUNCIL
Notary Public- State of Arizona
MARICOPA COUNTY
My Commission Expires Sept
NOTARY PaBLIC
My commission expires: 7--//
Followino approval please return this affidavit to the Maricopa County School Superintendents Office.