081716 DUPLICATE WARRANTS 2 - SCHOOLS.PDF

INTEROFFICE MEMORANDUM
Waricopa County School" Superintendent's Office
TO: CLERK OE TJ-IrE BOARD RECENED
FROM: Willie Thompson
SUBJECT: Affidavits JUL 2 6 2016
DATE: 7/22/2016 MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS
//0 L/NrAeL4:12,
PThase find attached 7 Affidavit/Arotice of Cfaim(s)for Cost warrants for incrusion on
the ne.Kt avaiCa6 Board agenda
.\1 The attached item(s) have been researched to ensure that the warrant(s) in
question have not been cashed or previous()) re-issued
-\1 The origincdwarrant(s) have had a stop payment done.
If you have any questions, pase contact Millie Thompson at 506.3898 or via e-mad at
mthompson@mcesa.maricopa.gov . Approved Affidavits may be routed back to the
Superintendent of School - Einance Division at 4041 X Central. Avenue #1200, ( 12 th
Tibor) Thankyou.
#21 glivRvey - EVALILA BrOGARIN - $727.83
#45 T'OWL ER ALICIA WHITWORE $1116.03
#66 ROOSEVELT .7-rosAww -4 yuDigyromv -ANDEz WARMNTS)
$317.75, $393.13, $393.13 es $86.11
#509 MARICOPA REGIONAL OLVYE9141SI AGBEBI $370.23

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.
Evalia Bugarin (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about (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 $ 727 .83 .(3)
Signed: (4)
ed and sworn to before me this /P day of 20
V.,,a)140
OTARY PUBLIC rmassommIMIMIIVINII•fln•I•••• /0041& 1111 OFFICIAL 111•”.•••••••••I11.1•="Ilmee. SEAL
BARBARA GRACIA j
.1 • siop/expires: • Notary Rd* - Slate afArizona
4e/(5) • td_ry MARICOPA room" 4-4k- es COUNTY 111..vt. ! A )
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 170001301
(if known) (6)
Original Date of Issue 07/14/2016
(if known) (7) .,, APPPnVED
Reason for original issue of Warrant/Check (8):
Payroll
0 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

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: gl Duplicate or 0 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.
Whitmore, Alicia (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 06/24/2016 (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 $ 1116.03 .(3)
Signed: (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 _J-(,)-11.I
NOTARY PUBLIC r . OFFICIAL SEAL •
JOANN BORUNDA
Notary Public - Arizona
My commission expires: My MARICOPA Commission COUNTY Expires
APRIL 113, 2617 (seal)
Warrant/Check Number 45217614
(if known) (6) 00 96/Li 't.)
Original Date of Issue 06/24/2016
(if known) (7)
APPituov
Reason for original issue of Warrant/Check (8): JZ2 8 2016
a Payroll DAT
El For Services or Goods furnished
El Treasurer's refund/payment
LI Other:
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc
Revised April 2015 A.R.S. 11-632 & 11-644

LQ
t
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.
Hosanna Judith Hernandez (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 10/01/2015 (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 Jae issued to him/her in the sum of $ 317 . 95 .(3)
Signed (4)
Notary Public State of Arizona
Maricopa County
Raquel Robles
My Commission Expires 07/0312017
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 160023039
(if known) (6)
Original Date of Issue 10/01/2015
(if known) (7) r - -
Reason for original issue of Warrant/Check (8):
111 Payroll
El For Services or Goods furnished
111 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

40
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.
Hosanna Judith Hernandez (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 10/15/2015 (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 $3933 43)
Signed! (4)
Notary Public State of Arizona
0 Maricopa County
Raquel Robles
My Commission Expires 07103/2017
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 160026292
(if known) (6)
Original Date of Issue 10/15/2015
(if known) (7)
Reason for original issue of Warrant/Check (8): in2 8 2016
El Payroll
El For Services or Goods furnished
III 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

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.
Hosanna Judith Hernandez (1), being first sworn, upon oath deposes and says:
—Warne/Claimant
On or about 09/17/2015 (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 De issued to him/her in the sum of $ 393 . 13 .(3)
Signed: (<1243.f,-e--t_ (4)
Notary Public State of Arizona
Maricopa County
My Raquel Commission Robles Expires 07/0312017
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 160020058
(if known) (6)
Original Date of Issue 09/17/2015
(if known) (7)
Reason for original issue of Warrant/Check (8): JUL18 2013
El Payroll
111 For Services or Goods furnished
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

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.
Hosanna Judith Hernandez (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 09 /0320 / 15 (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/checkjpe issued to him/her in the sum of $ 86.11 .(3)
Signe (4)
Notary Public State of Arizona
C Maricopa County
Raquel Robles
My Commission Expires 07/0312017
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 160014107
(if known) (6)
Original Date of Issue 09/03/2015
(if known) (7)
Reason for original issue of Warrant/Check (8): iLl 28 2013
0/ Payroll
0 For Services or Goods furnished
171/ Other: e 74414,04i 5 4a7et9/ ",,i/a/e/7- Tee e bte
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

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.
Oluyemisi Agbebi (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about --111 1,k4 (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 hi / er in the sum of $ 370 .23 .(3)
Signed: (4)
i) Subscribed and swqcn to before me this I day of )\ A \ 20 1 V.
0
NOTARY(16111BLIC
ELYSSA J. DEAR
NotmV Pubic - State ot AfiZOIYa
My commission expires: IARICOPA COUN1Y
-2_,c) uf7 MV commeesion - *2016 ExPifes (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 170001127
(if known) (6)
Original Date of Issue 7/8/2016
(if known) (7)
Reason for original issue of Warrant/Check (8): Pill 2 8 20
El Payroll
111 For Services or Goods furnished
LI 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