072016 DUPLICATE WARRANTS 3 - SCHOOLS.PDF

INTEROFFICE MEMORANDUM
Maricopa County Education Service Agency (aka
Maricopa County Superintendent of Schools Office)
TO: CLERK OF THE BOARD RECEIVE
FROM: Denise Weihe JUN 22 2016
SUBJECT: Affidavits — Replacement of Lost Warrants mArJcoRA c,our\rrY
CLERK BOARD OF SUPEQVISORS
DATE: 6/21/2016 // L_An'A-0-(-)-- 2
Please find attached 4 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.
#401 EVIT Sally Beauty Supply $281.04
#24 Gila Bend Richard Moore $79.28
#68 Alhambra Brad Walston $160.00
#68 Alhambra Elizeth Ilene Galaviz $368.03

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.
Sally Beauty Supply (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 02/3/2016 (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 $ 281.04
Signed (4)
(5) Subscribed and sworn to before me this / 51- day of 7-64 n 20
77
CATHY M REDING
My Commission Expires
October 25, 2016
My commission expii7s: I•I•I•••1011111 -••I
e2 ei2o-te- -776.3
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 460069859
(if known) (6) \
Original Date of Issue 02/03/2016 N
(if known) (7) \ -1. - ' \,..
Reason for original issue of Warrant/Check (8):
0 Payroll
I* For Services or Goods furnished
0 Other:
SAPROCESSESWarrants - Duplicate or Stale \02 Forms\Schools\Schools-Warrants Checks notice of claim.doc
Revised June 2015 A.R.S. 11-632 & 15-999

06/09/16
Attention Faye Claridge —EAST VALLEY I NSTITUE OF TECH
I have the authorization to get the check
Sincerely,
Sharon H
Credit
940.29

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.
Richard Moore (1), being first sworn, upon oath deposes and says:
Name/Uaimant
On or about May 26, 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 ofdDerjury, claimant hereby affirms that this_claim js-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 $ 79 .28 .(3)
Signed: (4)
(5) Subscribed and sworn to befofd this day of ,._/0/2e. 2016_.
NOTARY PUBLIC
MARGARET PERRY
My compission expVes: Notary Public - Arizona
Maricopa County
My Comm. Expires Nov 9, 2018 eal)
P"viza"zolcmci"
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 1 60087040/24544354
(if known) (6)
Original Date of Issue 05/26/2016
(if known) (7)
Reason for original issue of Warrant/Check (8): CA JU
gl Payroll
0 For Services or Goods furnished BC , --‘'P _ SUPERVISORS :}UNTY
0 Other:
Si \PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of cialm.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 MAR1COPA Instruction sheet which is page 2 of this form.
BRAD WALSTON (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about (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/cAeck be, issucd to hi j /her in the sum of $ 160.00 .(3)
4 c vi....._. (4)
Signed:
(5) Subsc fore me this (0-1- 1-\ day of 'n /-2 201(0.
NOTAR IC
CHERYLCARDER
My cort mt'ssiop/ expires: Naurou*.sitwornozono .MARIOOPA COUNTY : (seal)
Y7 (21-2 4:Inn* • *Wirt ENArasAug 12 20171
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 460092012 _
(If known) (6)
Original Date of Issue 04/14/2016 ' 7 11,0 11E
(If known) (7)
Reason for original Issue of Warrant/Check (8):
Fl Payroll JPERVISORS
El For Services or Goods furnished 68371217 NTY
D Other: 68371217
S:\PROCESSES\Warranls - Duplicate or Stale \ 02 Forms\Schools \Schools-Warrants Checks notice of claim.doc A.R.S, 11-632 & 15-999
Revised June 2015

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.
ELIZETH ILENE GALAVIZ (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about a I k 2C)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 be issued to him/her in the sum of $ 368.03 .( 3)
Signed: du/ (4)
(5) Subscribednd,s; 2016 .
••• I•••II 101
My commission expires: MONICA LOPEZ
Notify Public- State of/Vince i- (seal)
M.ARICOPACOUNTy ;
hi. 14 2aal
16•• Inam•••I•• I •••••711•11=1•••I•••11•10•••••••••I ••11.1.1011.*
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 (.)5- 3 -7
(if known) (6) — 6 - 00
Original Date of Issue 5-12-16
(if known) (7)
Reason for original issue of Warrant/Check (8):
Payroll
HiVISORS
0 For Services or Goods furnished MARICOPA COUNTY
0 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