090716 DUPLICATE WARRANTS 10 - SCHOOLS.PDF

INTEROFFICE MEMORANDUM
llaricopa County School-Superintendent's Office
TO: CLERXOE TOE 00AR9)
FROM: Willie Thompson
SUBJECT: Affidavits
DATE: 8/25/2016
Pfease find attached 2 Affidavit/Xotice of Cfaim(s)for Cost warrants for inclusion on
the next available Ooarc 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 warrant(s) have had a stop payment done.
If you have any questions, p lease contact Marie 'Thompson at 506.3898 or via e-mail at
mthompson@mcesa.maricopa.gov . Approved Affidavits may be routed back to the
Superintendent of School finance Division at 4041 X Central- Avenue #1200, ( 12 tfi
(Floor) Thankyou.
#59 LAVEEX WATSOX $1324.38
#98 EOVNTAIX.1-CILL5 Rrt)CrE .7-CASELET $540.30
RECEIVED
AUG 2 5 2016
MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: • Duplicate or 12 Stale-Dated (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.
Watson, Brianna (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about August 4, 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 to him/her in the sum of $1,324.38 .(3)
Signed: 1:9 _ (4)
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
(5) Subscribed and sworn to before me this day of 4usiL 201 .
•
NOTARY PUBLIC NAOMI ORONA
Notary Public - Arizona
My commission expires: My Comm. Mencops Expires County Apr 27, 2020 (seal)
AipM 62 `2/ ,212c
Warrant/Check Number
(if known) (6) 1 -10005581
Original Date of Issue
(if known) (7) a/H1201 to
Reason for original issue of Warrant/Check (8):
Payroll
0 For Services or Goods furnished
0 Treasurer's refund/payment
LI Other:
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc A.R.S. 11-632 & 11-644
Revised April 2015

'Ye
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.
6‘,/c2 po1/45.eley (1), being first sworn, upon oath deposes and says:
Name/Claima t
On or about g////c / (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 $ 3Y0 .(3)
Signed (4)
Subscribed and sworn to b e me this 91 day of 20 IL,
ei
NOTARY PUBLIC CAROLINE OFFICIAL C. SEAL LYNCH
'Notary Commission Public - Slate #340211 of Arizona
My corlimissiog expires: My MARICOPA comm. expires June COUNTY 22. 2019
aDtel
—°I
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) 17YKI° 76704
Original Date of Issue
(if known) (7)
Reasop for original issue of Warrant/Check (8):
.0 Payroll
111 For Services or Goods furnished
El 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