072016 DUPLICATE WARRANTS 8 - SCHOOLS.PDF

INTEROFFICE MEMORANDUM
Waricopa County School -Superintendent's 0_
TO: CLERK OE TOE 00ARD
FROM: Willie Thompson
SUBJECT: Affidavits
DATE: 7/7/2016
(Please find attached 2 AffidavitOotice of Claim(s)for lost warrants for inclusion on
the next avaita6 Ooard 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 (5) have had a stop payment done.
If you have any questions, please contact Willie Thompson at 506.3898 or via e-mail at
mthompson@mcesa.maricopa.gov . Approved Affidavits may 6e routed 6ack to the
Superintendent of School finance Division at 4041 5V: Central Avenue #1200, ( 12 th
'Floor) Thankyou.
#5 ISAAC AAEA $113.00
#5 ISAAC ROS A GAWCI.A 'FLOES $285.16
RECEIVED
JUL 08 2016
MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS
/CI tirks'd2r 4

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.
4/9,20/4 (--Goas, RosA (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about v,1(16(1 , 0 7/ ()oil° (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 $ At' .(3)
Signed: _e (4)
(5) S acribed and sw to before me this 4/L day of ,)0\t-, 20J t
Q
t-N-dLA ?
NOTARY PUBLIC —cirgainig.....
SANDRA APONTE
My connissiin expires: two Pubno-stale ofitattone
LH 11 2-0 2-0 my MAR1COPA Comm. Explres COUNTY Awl' 11, 2020 I (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
(If known) (6) 11 — ON 0 'ill
Original Date of Issue s-6 ; ,L,_ " _
(if known) (7) ‘/,/,9A0 1 i.i.
Reasonfor original issue of Warrant/Check (8): DAT JUL 12i
17VPayroll
111 For Services or Goods furnished ERK. MARICOPA BOARD OF COUNTY SUPERVISORS
0 Other:
SAPROCESSES\Warrants - Duplicate or Stale \02 Forms \Schools\Schools-Warrants Checks notice of clalm.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.
0-001 (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about Decernbev" 72-016 (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
warrantrheek be issued to him/her in the sum of $ I I 00 .(3)
(4)
EmiLy DagSod
(5) Subscrib, before me this day of 0
4010
OTA
KAYLA JACOBS
NOTARY PUBLIC - ARIZONA
mi sion expires: Pima County
1.4 My Commission Expires (seal)
AtrotiOt 14,010
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
(if known) (6) J4G - 004-714a3
Original Date of Issue
(if known) (7) 'teC.P.Mbili 10 72-016 ., ,
Reason for original issue of Warrant/Check (8):
D Payroll
tFc- For Services or Goods furnished SGNICeS
LI 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

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