080316 DUPLICATE WARRANTS 4 - 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
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 14 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 0 Stale -Dated (definitions are on page 2)
STATE OF ARIZONA Note: Numbers on this form correspond to numbers on the
COUNTY OF MAR ICOPA Instruction sheet which is page 2 of this form.
Salt River Project (1), being first sworn, upon oath deposes and says;
Name/Claimant
On or about July 8, 2015 (date)(2) a warrant/cheek 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 $ 40,718.53 .(3)
(4)
Note: Please attach a, copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
,wpfp to 1?efor"..kne this ,577-44- day of jULL/ 20/6 .
---- CHARNELL HALL 1
My commission expires: Notary Public- SUM Of AtiZoila
ANIP-0-44 j 2_011 My MARICOPA Commission COUNTY Expires (seal)
March 30, 2019
Warrant/Check Number . 460085248
(if known) (6)
Original Date of Issue March 24, 2016
(if known) (7)
Reason for original issue of Warrant/Check (8):
El Payroll
For Services or Goods furnished Ac44t4cv imvotc.0-
0 Treasurer's refund/payment
0 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

difillMit
Delivering More Man Power,TM
P.O. Box 52025
PHOEIVIA; AZ 85072-2025
(602) 236-5900
07/11/2016
Sally PerschBacher
Laveen Elementary
School District #59
5001 W. Dobbins Rd
Laveen, AZ 85339
Sally,
Please accept this letter as authorization for Kevin Attwood to act as agent for Salt River Project only to
request that a check be re-issued for payment of SRP Invoice# 6000022964.
The address to send the replacement check is:
Salt River Project
Miscellaneous Accounts Receivable
PO Box 52025
Phoenix AZ 85072-2025
/ -
Dale R. Politi
Assistant Treasurer
Salt River Project