072016 DUPLICATE WARRANTS 4 - SCHOOLS.PDF

INTEROFFICE MEMORANDUM
Maricopa County Education Service Agency (aka
Maricopa County Superintendent of Schools Office)
RECE1VFD
TO: CLERK OF THE BOARD
JUN 2 9 2016
FROM: Denise Weihe
mARicoP,AcCUINITY
SUBJECT: Affidavits — Replacement of Lost Warrants CLERK BOARD OF SUPERVISORS
DATE: 6/27/2016 i it) ofINeLad c
Please find attached 1. 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.
#79 Litchfield Jacob R Prast $304.95

DAT ui 2 9 2016
Schools Affidavit/Claim Form -RK BOARD OF SUPERVISORS
MARICOPA COUNTY
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 pa ge 2 of this form.
ex) b R. Pr6S+ (1), being first sworn, upon oath deposes and sa ys:
Name/Claimant
On or about qI 2 (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 subse q uently inadvertentl y lost or destroyed and there is
no reasonable probability of its bein g found or presented for pa yment, or it was not
presented for pa yment 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 owin g, and the applicant re quests that a replacement
warrant/check be issued to Jii mTher in the sum of $ 3044. .(3)
Si g ned: (4) (4)
(5) Subscribed and sworn to before me this day of ) e_ 20/(
67,
NOTARN'xUBLIC BRITTANY CARTER
Notary Public
My commission expires: Maricopa County, AZ
Qr)Icy My Commission(pplfes
‘,.)9 April 29, 2019
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(o 00S)-676
(If known) (6)
Original Date of Issue sue 1 14.(0
known) (7)
Reason for ori ginal issue of Warrant/Check (8):
Payroll
LI For Services or Goods furnished
0 Other:
5: \ PROCESSES \Warrants - Duplicate or Stale \ 02 Forms \Schools \Schools-Warrants Checks notice of clalm.doc
Revised line 2015 A,R,S. 11-632 & 15-999

MCESA
Maricopa County Education Service Agency
INTEROFFICE MEMORANDUM
Maricopa County Education Service Agency
TO: Clerk of the Board RECEIVED
FROM: CARRIE GUNDERSON
JUN 2 9 2016
SUBJECT: Affidavits — Replacement of Lost /Stale Warrants
DATE: 6/21/2016 MArilGOl'A COUNTY
CLERK BOARD OF SUPERVISORS
01/1•4tt'c'e
PLEASE FIND ATTACHED 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.
The original warrant(s) have had a stop payment done.
If you have any questions, please contact ELSA PEREZ at (602) 506-3533 or via e-mail at
garnishments@mcesa.maricopa.gov . Approved Affidavits may be routed back to the Maricopa
County Education Service Agency at 4041 N. Central Avenue #1200, (12th Floor) Thank you.
Fund 781
Jauregui,Graciela 160091711 $1,427.31
Jauregui,Graciela 1 6009171 2 $578.23
4041 N. Central Avenue, Ste. 1200, Phoenix AZ 85012 • Phone 602-506-3866 • Fax 602-506-
3753
www.nnaricopa.gov/rncesa Twitter: #mcesaaz Facebook: mcesaaz

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: 1111 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.
Jauregui, Graciela (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about June 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 $ 1,427.31 and $578.23 .(3)
Signed: (4)
Note, Please atta' 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 before me this o23r day of ite_ 20 (t2
I1111w"-,'
41111111I
VOTAR'Y PUBLIC
SHAMRA BUNN
My commission expires: Notmy Patric- State of Arizona
MARICOPA COUNTY
fre- My Commission Expires (seal)
February 20, 2019
160091711 and 160091712
Original Date of Issue 6/9/16 and 6/9/16
(if known) (7)
Reason for original issue of Warrant/Check (8):
II Payroll
0 For Services or Goods furnished
CI Treasurer's refund/payment
111 Other:
SAPROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc
Revised April 2015 A.R.S. 11-632 & 11-619