090716 DUPLICATE WARRANTS 5 - 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: 8/8/2016
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 City of Glendale Police Dept $9399.10
#98 Fountain Hills ; AZ Brake & Clutch $1071.64
RECEIVE-
AUG -. 8 2016
mARiccrA
CLERK BOARD OF SUPERVISORS
/0 tiyyko_-J

07/06/2016 06:43 4806645099 FHUSD PAGE 02/02
Affidavit
STATE OF ARIZONA
COUNTY OF MARICOPA ) :30ARDOFSu"ERVIS:
MAMCOPACOUNTY
PLC
AZ • L 1 i16 •ti# being first duly sworn, upon oath deposes and says:
That on the I day of JUAIC , 20/4. he presented to the
taiLL,C L 5.49. of Maricopa County, for payment, a claim for services
rendered or supplies furnished during the month of Lheit/E , said claim being
in the sum of ..5/7 444zry• elve-±ty Dollars (07 7/ - di
in payment of which the Superintendent of Schools caused his/her Warrant No.4'4C) /(4ir/7
to be issued on it,e0E 4P-/ , 201, drawn on the t9 1/0 Fund of
5 0 " 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, Orient prays that the Board of Supervisors order and the Superintendent of
Schools issue to him a duplicate of said warrant number 1440 11 9&/7 in the sum of
$ /0 7/ . 4.‘,/
44 a. /32-44g,,,..,
Subscribed and sworn before me this day of
_
itaillbragiariaelb4WbrairafroI„I,„. AO °411111V-4511-
•s''''''f,. KATHLEEN JANE STORY (11K ;sia, ,At n ubIlc
0 u ,.,ota,rx. JENblic - Arizona
<11 1 p-'1 FAMOpa County
My Comm. Expires Mar 18, 2019
, 3ilipmrI••I•••I•I••I••III•I•I04 • My Commission Expires
Following approval please return this affidavit to the Maricopa County School Superintendent's Office.
HAWork \Affidavit,doq 07114/05

Lit
Arizona Br,a.fr,e Moe II R. C)t.J.,trh. ,SAL.1 4rio,!,r Inr
P.O. Box 6369 • Phoenix, AZ 85005 • 2211 N. Black Canyon Highway • Phoenix, AZ 85009 • (602) 256-7966 • Wets 1-800-352-6301 • Fax (602) 254-1283
TO WHOM IT MAY CONCERN:
IN ANY AND ALL MATTERS RE: THE REPLACEMENT OF WARRANT
#460114817 IN THE AMOUNT OF $1071.64, SUSAN A. BAKKEN
IS AN AUTHORIZED SIGNER FOR ARIZONA BRAKE 81. CLUTCH
SUPPLY INC.

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.
City of Glendale Police Department (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about June, 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 tq him/her in the sum of $ 9,399 . 10 .(3)
Signed: IDA (4)
(5) S2.i cribed and s/Orn to fore me this e day of
PUBLIC
LINDA S. BERG
Notary Public - State of Aft0118
MARICOPA COUNTY
My September Commission 4, 2018 Expires (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 460108020/214730024
(if known) (6)
Original Date of Issue 6t /16
(if known) (7) I A
Reason for original issue of Warrant/Check (8):
LI Payroll
LI For Services or Goods furnished
El Other: SRO for Copper Canyon High School
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

a memorandum from the
Glendale Police De artment
Integrity • Courage • Excellence • Respect • Compassion Dedication
DATE: March 28, 2016
TO: Henriette Cooper, Tolleson Union High School District #214
FROM: Denise Krause, Glendale Police Dept
SUBJECT: Missing check #214726876
I am a Senior Management Assistant employed by the City of Glendale. Among other
duties, I supervise David Rice who is responsible for billing and accounting for payments
in connection with the School Resource Officer (SRO) program. Mr. Rice has personal
knowledge of the facts relating to the SRO billing and is authorized to sign the affidavit
dated March 16, 2016, relating to a lost check for services rendered.