081716 DUPLICATE WARRANTS 3 - SCHOOLS.PDF
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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: 7/25/2016 Please find attached 1 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. #94 Paloma Arizona Public Service $3656.23 RECEIVED JUL 2 6 2016 MARICOPA COUNTY CLERK A a BOARD OF SUPERVISORS //0 ‘AfVN4AA:212 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. Arizona Public Service (1), being first sworn, upon oath deposes and says: Name/Claimant On or about b5OLIpOio (date)(2) a warrant/check was issued to the above named person/en ity 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 $ 3656.23 .(3) Signed: .,a,(41/ 114(77Ga‘f (4) 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 460105254 (If known) (6) Original Date of Issue 05/24/2016 (If known) (7) 28 2015 Reason for original issue of Warrant/Check (8): 0 Payroll WI For Services or Goods furnished 0 Other: SAPROCESSES\Warrants - Duplicate or Stale\ 02 Forms \Schools \Schools-Warrants Checks notice of claim.doc Revised June 2015 A.R.5. 11-632 & 15-999 n aps Station 3209 P0 Box 53933 Phoenix AZ 850723933 Date: 7/21/2016 State of Arizona County of Maricopa Ref: Affidavit Warrant/Check The following individuals are authorized to sign as a representative of Arizona Public Service: Delia McNally Susie Soto Sincerely, APS REVENUE RECOVERY DEPT.