080316 DUPLICATE WARRANTS 1 - 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: 7/14/2016
Please find attached 3 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.
#59 Laveen Salt River Project $40718.53
#59 Laveen Joshua Tyler Brownfield $585.26
#68 Alhambra Andrew Feight $95.00
RECEIVED
JUL 1 4 2016
MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS

ophication fo t pcte StaNe-Oated4liarran,',-/Check
AffidavitiOahli1 Form
This appiicatim is foil 7-1 Duplicate or Li 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.
Joshua Tyler Brownfield (I), 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
anYcheck be issued to him/her in the sum of $ 585.26 .(3)
igbed: (4)
Notp,%Please ati15,14----a—copy of the warrant/check if available and/or any other
evidence that warrant/check was originally issued.
(5) Subscribed and sworn to before me this (QM day of III \I 20 (c)
AtiS1/2
NOTARY PU JC
My commission expires
***
‘.107,1,9, • (seal)
Warrant/Check Number syAk ,ou
if known 6 160012184 BL C
Original Date of Issue ......... •
(if known) (7) 8/27/2015 iisti/ VVI S.0°,0% I
Reason for original issue of Warrant/Check (8): APPIROVir;
W- Payroll JUL 5 2016
DATE,.
0 For Services or Goods furnished /141
w fk.,I7
LI Treasurer's refund/payment '5ARD Or--uPthNTSORS COLN-Y
Ei 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

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.
ANDREW FEIGHT (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 5/0,9q )li0 (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 $ 95 .00 .(3)
Signed: (4)
rn to before me this IL 'N. day of 20 I G.
OFRGIAL SEAL
CHERYL CARDER I
My com( ftsign ezpires: Notary Putic -Slate of Attona
27 ( My MARICOPA Comm Expires COUNTY Aug. 12, 2017 ;• (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 (if known) Number (6) RF-1516-130 ' i( 0 I 05//0
Original Date of Issue 05/24/2016
(if known) (7)
Reason for original issue of Warrant/Check (8):
El Payroll
171 For Services or Goods furnished RF-1516-130
El Other RF-1516-130
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