072016 DUPLICATE WARRANTS 2 - SCHOOLS.PDF

INTEROFFICE MEMORANDUM
Maricopa County Education Service Agency (aka
Maricopa County Superintendent of Schools Office)
TO: CLERK OF THE BOARD
FROM: Denise Weihe RECEIVED
SUBJECT: Affidavits — Replacement of Lost Warrants JUN 2 4 2016
DATE: 6/23/2016 MAR ICOPA COUNTY
CLERK BOARD OF SUPERVISORS
I/0
Please find attached 1 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.
#509 Maricopa Regional Logical is $688.49
#66 Roosevelt Taylor Wonderling $242.88
#216 Agua Fria Josh Nichols $28.18

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.
Log calls (1), being first sworn, upon oath deposes and says:
Name/Claimafit
On or about April 14, 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/c e_issued to him/her in the sum of $ 688 .49 .(3)
Signed: (4)
(5) Subscribed and sworn to before me this / tjts- day of 201(),
'NOTARY PUBLIC CHRISTOPHER G.BANERIAN
NOTARY PUBLIC, STATE OF MICHIGAN
My commission expires: COUNTY OF OAKLAND
Pcf"e* 12 3/zt),24 ACTING MY COMMISSION IN THE COUNTY EXPIRES OF6,,I,LA. 1.2/3/1-‘ 2-1
Note,' Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
r Warrant/Check Number 460092342
, Of known) (6)
Original Date of Issue 4/14/2016
(if known) (7) , — at, Jul
Reason for original issue of Warrant/Check (8): DA JU
0 Payroll
IJ For Services or Goods furnished April 2016 - MCRSD CLERK, BOARD OF SUPERVISORS
MA A COUNTY
LI Other: April 2016 - MCRSD
SAPROCESSES\Warrants - Duplicate or Stale\02 Forrns\Schools\Schools-Warrants Checks notice of claim.doc
Revised June 2015 &RS 11-632 & 15-999

LOGICALIS 2600 S. Telegraph Road
Suite 200
Business and technology working as one Bloomfield Hills, MI 48302
T 248.957.5600
F 248.957.5601
www.us.logicafis.com
Bonnie Romo
HR/Finance Coordinator
Maricopa County Regional School District
Via eMail
June 23, 2016
To Whom it May Concern:
This letter hereby confirms that Jeanne Beisiegel is authorized to sign, on behalf of
Logicalis, Inc., the attached "Application for a Duplicate Warrant/Check."
Very Truly Yours,
Eric Tilds
Executive VP and General Counsel
Logicalis, Inc.

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.
Taylor Wonderling (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 6/9/2016 (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 $ 242.88 .(3 )
Signed: (4)
orn to before me this day of j1fitii-5 20 ik .
Notary Public State of Arizona
Maricopa County
My commission expires: Ashley My Commission Ann Michel Expires 0710312017
C/9/201t 7/,-.3/2 (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 16-0090600
(if known) (6)
Original Date of Issue 6/9/16
(if known) (7) *1 ••-,,,'
Reason,for original issue of Warrant/Check (8):
Payroll
0 For Services or Goods furnished
Ii Other: I rda akL 'a) 416 Ma .; (
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

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.
CIO I (1), being first sworn, upon oath deposes and says:
ame [alma t
On or about 1)-1)7 // 5 (date)(2) a warrant/check was issued to the
above named persdnientity 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 Ln the sum of $ 1_0,0 .(3)
Signed: (4)
) Subscribed and ,worn to before me this day of 20
OTARY PUBLIC OFFICIAL SEAL
ANDREA L. CRAWLEY
Notary Public - State of Arizona !
My c mmi sion eAresinri My MARICOPA Comm. Expires COUNTY July 17, 2017
1, g.) (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) I (.e 004 '-/ 'I -7 ‘-1
Original Date of Issue
(if known) (7) I Z-71 - 7 /01 - 6--
Reason for original issue of Warrant/Check (8):
)4 Payroll
0 For Services or Goods furnished
El Other:
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