080316 DUPLICATE WARRANTS 8 - SCHOOLS.PDF

INTEROFFICE MEMORANDUM
Waricopa County School-Superintendent's Office
TO: CLERK OE DIE WARD
FROM: 911i1iie Thompson
SUBJECT: Affidavits
DATE: 7/18/2016
Pase find attached 2 Affidavit/NOtice of Claim(s)for rost warrants for inclusion on
the next avaiCa6 oard agenda
The attached item(s) have 6een researched to ensure that the warrant(s) in
question have not 6een cashed or previously re-issued
The original. warrant(s) have had a stop payment done.
If you have any questions, please contact %tete Thompson at 506.3898 or via e-mail at
mthompsongmcesa.maricopa.gov . Approved Affidavits may 6e routed back to the
Superintendent of School 'Finance Division at 4041 7V CentrarAvenue #1200, ( 12 th
'Floor) Thankyou.
#45 'FOWLER MARVIN - GRANT $ 156.40
#59 LA VEEN - E.IIILY SOLT'S $856.82
JUL 2 () 2016
MARCUM wuNry
CLERK BOARD OF SUPERVISORS
1121-o fl\ OOL

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/ Claim Form
This application is for: IN 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.
Emily Soltis (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 7/31/2015 (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 $ 856.82 .(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 befbre me this U__.) day of 0,4A ---- 20 1 .
0)9k (11/7
NOTARY PUBLIC I EOM LOVE-NYANOR
NOTARY PUBLIC- STATE OF MICHIGAN
My commission expires: COUNTY OF KEW
-I -7-17 MY COMMISSION EXPIRES DECEMBER 17, 2017 (seal)
Warrant/Check Number 160004722
(if known) (6)
Original Date of Issue 7/31/2015
(if known) (7)
Reason for original issue of Warrant/Check (8):
gi Payroll
0 For Services or Goods furnished
0 Treasurer's refund/payment -
ID Other:
S:\PROCESSES\Warrants - Duplicate or Stale\OZ Forms\Warrants Checks notice of claim - Copy.doc
Revised April 2015 A.R.S. 11-632 & 11-694
sRK. BOARD OF SUPERVISORS
lviAiRld0PA CC' , N,v

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.
-14r (1), being first sworn, upon oath deposes and says:
Name/Crum
On or about (k./ 8- 20 I 1 (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 bejssued to him/her in,.the sum of $ /S76 .( 3 )
(4)
ubscribe rn to before me this 1,-S day of
NOTARY PUBLI
OFFICIAL SEAL
My coiTimission expires: Notary BARBARA Public M. - Arizona GILL
1 d_ti I MARICOPA COUNTY (seal)
My Commission Expires
-
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued,
Ndk
Warrant/Check Number
(if known) (6) 0 0onog?-6 95-2-„L2Tz 2-
Original Date of Issue
(if known) (7) 7/g 1z
Reason for original issue of Warrant/Check (8):
xr Payroll
LI For Services or Goods furnished
Li 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