081716 DUPLICATE WARRANTS 4 - SCHOOLS_REDACTED.PDF

INTEROFFICE MEMORANDUM
Waricopa County School 'Superintendent's
TO: CLEVC oq D-CE 00ARD
FROM: Willie 'Thompson
SUBJECT: Affidavits
DATE: 7/28/2016
PThase find attached 1 Affidavit/Xotice of Claim(s)for Cost warrants for incrusion on
the ne.-t available Ooard 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 original warrant(s) have had a stop payment done.
If you have any questions, p lease contact Millie 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
Efoor) Tfiankyou.
#44 AVONDALE KELLEToERGLrogvo $659.46
#59 LAVE .ANA .71-ENDEW5OX $119.35
#81 1\ADAOVRG ELE714 0 'Lov gyrnw . $837.10
4- (A( c&Laie_ QS 4 NI 2. 41-4‘07,
JUL 2016
CLET:

Lk-)
AFFIDAVIT
STATE OF ARIZONA
COUNTY OF MARICOPA
y_6\w, Beir9,,kka, being duly sworn, upon oath deposes and says:
That on the V2VA day of _)kiLYN-t. , 2-61i U he/she presented to
the Avondale Elementary School District of Maricopa County, for payment, a claim for services
rendered or supplies furnished during the month of AVM./ , 2_61U , said claim being the
- L9
sum of SI\( htalVtii (A-k\- 01Yk.4) tc" dollars ($ (.059 41.0 ) in payment of which the
Superintendent of Schools caused his/her Warrant Number 1 U609 St53 to be issued on
, 201 t-o , drawn on the t30 Fund of Avondale Elementary School District of
Maricopa County, Arizona.
Claimant further says that although he/she was informed and believed that the above-
mentioned warrant was regularly issued, the same has never been received or has been lost. Under
penalty of perjury, claimant hereby affirms that this claim is correct and the amount shown is due
and owing.
Wherefore, claimant requests that the Board of Supervisors order and in the Superintendent
of Schools issue him/her a duplicate of Warrant Number I UM 9>V0?) in the sum of
6251 .1-t u
Claimant Signature
1, /
Sublcribed and sworn before me this 2644)\ day of
My commission expires: -2-6161
(Notary Public)
Seal: i 011% 0 OFFICIAL SEAL
! IMFORi AURA NELSON j
Notary Pubic - State clieizona
MARICOPA COUNTY I
My Comm. Expires Dec. 28, 2019 I
Following approval please return this affidavit to Maricopa County Education Service Agency

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: ER 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 MARICDPA Instruction sheet which is page 2 of this form.
Ana Henderson (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about August 27, 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/che be issued to him/her in the sum of $ 119.35 .(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 20 /6 .
aL5*
NOTXRY PUBLrc-
MELANIE B HAMMON
NOTARY PUBLIC — ARIZONA
My commission expires: MOHAVE: COUNTY
My Commission Expires
October 17, 2017 (seal)
Warrant/Check Number 160012187
(if knowni (6)
Original Date of Issue August 27, 2015
(rf known) (7)
Reason for original issue of Warrant/Check (8):
Payroll
El For Services or Goods furnished
Treasurer's refund/payment
CI Other:
S:\PROCESSES\Warrants - Duplicate or stale\02 Forms\Warrants Checks notice of claim - C,opy.doc
Revised April 2015 A.R.S. 11-632 & 11-644

AFFIDAVIT
STATE OF ARIZONA 1
COUNTY OF MARICOPA
Ellen Marie O'Loughlin , being first duly sworn, upon oath deposes and says:
That on the 14 day of June , 2016 , he/she presented to
Nadaburg District of Maricopa County, Arizona, for payment, a claim for services rendered or supplies
furnished during the month of June 2016 , said claim being in the sum of
EightHundredThirtySeyen and 10/100 Dollars, ($837.10 ) in payment of which the
Superintendent of Schools caused his/her Warrant Number 170002011 (81547541) to be issued on June
14, 2016 , drawn on the 100 Fund of Nadaburg District of Maricopa County, Arizona.
Affiant further says that although 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 prays that the Board of Supervisors order and the Superintendent of Schools
issue to him/her a duplicate of said Warrant Number 170002011 (81547541) in the sum of $837.10.
Signed:
Ellen Marie O'Loughlin
Subscribed and sworn before me this 291' ) day of _14 a /
JOSUE GUZMAN CRUZ
Notary Public-State of Arizona Notary—Public
MARICOPA COUNTY
My Commission Expires 714,y I
July 1, 2018 My commission expires:
{....7.111..•••••• •••
Following approval please return this affidavit to the Maricopa County Superintendents Office.

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 tl -Tis form.
Hernandez, Alexis A. (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 $ 407.86 .(3)
Signed: I e ,{1104latIta- (4)
before me this of Tk 20/&.
OFFICIAL SEAL
MATTHEW TIMOTHY CAMACHO
Notary Public - Arizona
My o =Fires: MARICOPA COUNTY
My Commission Expires
igni=„9„.00,140.9k _ . (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 45217294
(if known) (6)
Original-Date of Issue 06/24/2016
(if known) (7) I _
Reason for original issue of Warrant/Check (8):
Payroll
El For Services or Goods furnished
El Other:
SAPROCESSES\Warrants - Duplicate or Stale \02 Forms\Schools\Schools-Warrants Checks notice of claim.doc
Revised June 2015 A.R.S. 11-632 & 15-999