090716 DUPLICATE WARRANTS 8 - 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: 8/12/2016
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.
#31 Balsz Raising a Reader $6411.00
RECZWED
AUG 1 2 2016
MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS
1/ LAAAjit;-0 Cql

AFFIDAVIT APPROVED
AU 27016
STATE OF ARIZONA DAT
COUNTY OF MARICOPA RK MARICOPA BOARD CP- COUNTY
KrAl .S I (L) C /(-) , being first duly sworn, upon oath deposes and sa ys:
(Name and Title of Person)
That on , 20 / ,he/she presented to f9LSZ SC-HOW- J ' ,ST-- of
(School District Name)
Maricopa County, Arizona, for pa yment, a claim for services rendered or supplies furnished durin g the
month of --3f)x-D Unr2-16 , 20 ILo,said claim being in the sum of ($ [.GO )
1410Dezo 'It_i_Ju6loczr)cet,itoDollars in payment of which
the Superintendent of Schools caused his/her Warrant Number (1(490 0 (a q 1-17 to be issued
on 1. I , 20 / te , drawn on the 101 Fund of 'Int-CZ IS)Ct4.66/- ht ST. # 31 of
(School District Name)
Maricopa County, Arizona.
Affiant further sa ys that althou gh 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 pra ys that the Board of Supervisors order and the Superintendent of Schools issue
to him/her a duplicate of said Warrant Number .() (.60 1,0q y 7 in the sum of $ 6 , (-/ .60 .
Signed:
(Rime and Title of A.uthorl7ed Personnel)
Subscribed and sworn to before me this IVA\ day of V\CX.A.A , 20 I (0
5ce,
NOTARY PUBLIC:
My commission expires: \
Following approval please return this affidavit to the Ma ricopa County Education Service Agency Office.

CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE § 8202
V See Attached Document (Notary to cross out lines 1-6 below)
El See Statement Below (Lines 1-6 to be completed only by document signer[s], not Notary)
Signature of Document Signer No. 1 Signature of Document Signer No. 2 (if any)
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California Subscribed and sworn to (or affirmed) before me
County of 5--4.4 1 Mq-/-6.0 /
on this 1/ -14 day of /14a-f-/ , 20
by Date M6nth Year
(1) SWEL.i.-/ AVYIVE
MARIA ARLEEN ARNAL
Commission # 2036158
Notary Public - California (and (2) ),
San Mateo County it Nameffi of Signer/0
Comm. Expires Aub 9. 20171
proved to me on the basis of satisfactory evidence
to be the person() who appeared before me.
Signature
Signature of Notaty Public
Seal
Place Notary Seal Above
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Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
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S4,I.1/4S1/4:.1.6f4S1/4S1/4c.LW.S.1/4S•1/4.:.1/VA:41‘4,..1/41/4.:,1/4S1./41/4,:.%4S1/4,,,,;(4...,!;4\1/41:4,1/4\,1/4,,I,‘4,,,/4S,1/:Nle.4\1/4\,2e4,1/4/4.:,,y4S'S1/4;,!/4,,,t/4\,,,;4\,!..!4S,/,:v1/4\.1/4v1/4\,1,".4\.1/4'
©2014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5910

Raising
A Rader e
TO: Stephanie Bastin
Balsz School District #31
DATE: 11 May, 2016
FROM: Shelly Coulter
Raising A Reader
RE: Invoice #56341
Hello Stephanie,
Please find attached the signed and notarized affidavit regarding the check lost by our
bank. This is for your check warrant #460069479 for $6,411.00.
Regards,
Shelly M Coulter
650-489-0550
Raising A Reader National Office East Coast Office www.raisingareader.org
Sobrato Center for Nonprofits - Redwood Shores 810 Cromwell Park Drive rarinquiry@raisingareader.org
330 Twin Dolphin Drive, Suite 147 Suite K main: 650.489.0550
Redwood City, CA 94065 Glen Burnie, MD 21061 fax: 650.489.0551

To Balsz School District
Our Senior Accountant, Shelly Coulter, has authority to sign the affidavit in regards
to the lost check sent to Raising A Reader.
Thank You,
Gabrielle E Miller
President & CEO
Raising A Reader
Sobrato Center for Nonprofits — Redwood Shores
330 Twin Dolphin Dr, Suite 147 I Redwood City, CA 94065
Tel 650.489.0550 I Fax 650.489.0551 1 www.raisingareader.org