072016 DUPLICATE WARRANTS 11 - SCHOOLS.PDF

INTEROFFICE MEMORANDUM
Maricopa County Education Service Agency (aka
Maricopa County Superintendent of Schools Office)
RECEIVED
TO: CLERK OF THE BOARD JUL 1 2 2016
FROM: Denise Weihe MARICOPA
SUBJECT: Affidavits — Replacement of Lost Warrants CLERK BOARD 0,-;
DATE: 7/12/2016
Please find find attached 9 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.nnaricopa.gov. Approved Affidavits may be routed back to the
Superintendent of School Finance Division at 4041 N. Central Avenue #1200, (12th
Floor) Thank you.
#60 Higley Christopher Brock $993.86
#60 Higley Christopher Brock $993.86
#60 Higley Christopher Brock $993.90
#60 Higley Christopher Brock $993.86
#60 Higley Empire Southwest LLC $632.44
#60 Higley Gadell LLC $852.08
#66 Roosevelt Matthew Patriquin $269.84
#79 Litchfield Sounds Academy $1800.00
#5 Isaac Rosa Garcia Flores $285.16 _rte

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.
Christopher Brock (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about (f- (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 $ 993 . 86 .(3)
7
Signed: (4)
and sworn to before me this lc d‘" day of T. 20
• I•I•••I•••••••II • II••II ••I•• I••••••
NOTARY PUBLIC OFFICIAL SEAL I
LEAH CRUZ i
Notary Pubtic - State of Arizona I
My commission expires: MARICOPA COUNT( I
t.. .1,1-iii---1,r My Comm. ElviresOci 26, 2019 I
10" dlo (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 60465749 i (A 0gC1 1
(if known) (6)
Original Date of Issue 06/09/2016
(if known) (7)
Reason for original issue of Warrant/Check (8):
Payroll
LI 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

;OD
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 pa ge 2 of this form.
Christopher Brock (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about (p/22/7/(..- (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 $ 993 . 86 .(3)
Signed: (4)
(5) Subscriby an sworn to before me this --)! day of 20 L;, .
NOTARY PUBLIC OFFICIAL SEAL I
LEAH CRUZ j
Notary Public -State of Arizona I
My commission expires: MARICOPA COUNTY 1
Icy d co ri...:(4 . My Comm. Expires Oct 28, 2019 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 60466200 l(p00?/10
(if known) (6)
Original Date of Issue 06/09/2016
(if known) (7) ---- _
Reason for original issue of Warrant/Check (8):
Payroll
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

44)
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.
Christopher Brock (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about &Mize/cc (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 $ 993 . 90 .(3)
Signed: t (4)
(5) Subscrib0 an sworn to before me this g day of 20 tu.
NOTARY PUBLIC
LEAH CRUZ j
My commission expires: Notary Public - State of Arizona
M.ARICOPA COUNTY I
to- Q-6 rci My COMM. Expires Oct. 26 2019 1 (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 60468289 1CP 60136 ,
(if known) (6)
Original Date of Issue 06/09/2016 _ ___ _
(if known) (7) 1
Reason for original issue of Warrant/Check (8): JUL1 3 2015
DAT FA
l=1 Payroll
El For Services or Goods furnished K. BOARD OF SUPERVISORS
MA LOU
CI 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

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.
Christopher Brock (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about /_g/23/2.e/L (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 $ 993 . 86 .(3 )
Signed: (4)
sworn to before me this gIS day of TA..—e 20 IC,.
OFFICIAL SEAL
3 - -ires LEAH CRUZ
My commission expires: Notary Pubilo - State of Alizona
MAR1C0PACOUNTY
My Comm. Expires Od. 26, 2019 I, (seal)
— 1.1•0 11.I ••••••• • •I • • 11•••••••I• •• NMI"
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) 60466642 i 'GOO / 10°174
Original Date of Issue 06/09/2016
(if known) (7)
Reason for original issue of Warrant/Check (8):
Payroll
El For Services or Goods furnished
lii 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

1 5176 6/23/16 15:50
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.
Empire Southwest, LLc (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about )7/ II / 1 6, (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 $632.44 .(3)
Signed: L),-/v\-OLA V MU/4r (4)
(5) Subscribed and sworn to before me this IA day of
NOTARY PUBLIC
ELEANOR 0. RAMIREZ
Notary Pubic- Stsb3 of Arizona
My commission expires: My MARICOPA Commission COUNTY Expires
64e144,iit if oi8' August 14,2018 (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 460062805
(if known) (6)
Original Date of Issue 01/14/2016 'UL *8 20 0 ,
(if known) (7) A
—
Reason for original issue of Warrant/Check (8): OF SUPERVISORS
El Payroll .20PA COUNTY
111 For Services or Goods furnished e n 111,s 37 g. le 3 Eth PS' 8- 3 38(0
111 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

CERTIFIED COPY OF A CORPORATE RESOLUTION
OF THE BOARD OF DIRECTORS
OF
THE WHITEMAN FAMILY CORP.
I, Brian Hansen, hereby certify that I am a duly elected, qualified and acting
Secretary of The Whiteman Family Corp., an Arizona corporation, the managing member
of Empire Southwest, LLC, a limited liability company organized under the laws of the
State of Delaware, and authorized to do business in the State of Arizona; that the
following is a true and correct copy of a Resolution duly adopted at a meeting of the
Board of Directors of The Whiteman Family Corp. held on 1,./4-( lq- 201-6;
that there were present at said meeting the required number of directors to constitute a
quorum, all of whom voted in favor of the following Resolution; that said Resolution has
been duly recorded in the minutes of said corporation and has never been amended,
modified, rescinded or revoked. Said Resolution being:
IT IS RESOLVED, that the following individuals be and they
hereby are authorized to execute lien waivers and joint checks
on behalf of Empire Southwest, LLC:
John Helms, Vice President and Chief Financial Officer
Rob Wahlin, Financial Marketing Director
Cindy Miles, Credit Account Manager
Rolland Shill, Credit Account Manager
Betsy O'Neill, Credit Account Manager
Mary Kuhel, Credit Account Manager
Christina Coates, Credit Account Manager
IT WITNESS WHEREOF, I have hereunto set my hand and affixed the seal of
said corporation this 1 day of 1,416,--1 , 2016.

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.
6V1lairnant eL. (1), being first sworn, upon oath deposes and says:
On or about 6 /19--) )(0 (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 penal of perjury, claimant hereby affirms that this claim is correct
and the amount shoi is due and owing, and the applicant requests that a replacement
warrant/check ssuod tAifh/berin the sum of $ 5 a socc3 .(3)
Sig (4)
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 9/40 009 o92
(if known) (6)
Original Date of Issue 0 L ,a7 FA JUL S 2016
(if known) (7)
Reason for original issue of Warrant/Check (8): -
CI Payroll MARICOPH COUNTY
VI, For Services or Goods furnished
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

1 -
v
RECEIVED BY HUSD 4
Lisa G. Bate
Accounts payable Specialist JUN 3 0 2016
Higley Unified School District #60 ,
2935 S. Recker Rd FINANCIAL SER WES
Gilbert, AZ 85295
June 28, 2016
Hello,
Enclosed is the signed notarized affidavit from Gary Sachs, regarding the check replacement criteria for
the payment of Invoice # 024099, datejk 3:14-16 that was accidentally sent to our old address.
Gary Sachs is the owner of:
Gadel LLC
dba Downtown Locksmith Car Keys Unlimited
137 W. McDowell Rd.
Phoenix, AZ 85003
If you have any further questions please feel free to call,
Candi Shaw
Office Manager
602-253-6916
137 W. McDowell Rd. Phoenix, AZ 85003 • Downtownlocksmith.com • 602-253-6916 FAX 602-253-3374

AFFIDAVIT
STATE OF ARIZONA
COUNTY OF MARICOPA CLERK, MARICOPA BORR.) _ F SUPERVISORS COUN TY
i•Ae),NVi\e-u-) being first duly sworn, upo1 11 ath deposes and says:
That on the 23day of LcOu'lq0 I k he presented to Oblevei 4 Ittor) 1 aSk !e;
District of Maricopa County, Arizona, for payment, a claim for services rendered
or supplies furnished during the
month of \LAJA4,2.,Le 20 , said claim being in the sum of
kwireok 44tistoia ci-Vi4 Dollars, ($ 2 teq, in payment of which the
Superintendent of Schools caused his/her Warrant Number 21.0.:_b/0 ?1/43/7 to be
issued on Le Li , 20 itt, , drawn on the Fund of ?—
District of Maricopa County, Arizona.
Affiant further says that although he/she was informed and believes that the above
mentioned warrant was regularly issued, the same has never been received, or has
been lost.
WHEREFORE, affiant prays that the Board of Supervisors order and the
Superintendent of Schools issue to him/her a duplicate of said Warrant Number
*0075,7 in the sum of $ 210 41. ii)-1"
Signed:
Subscribed and sworn to before me this day of
WVICAZO.ckh'N/9
NOTARY PUBLIC
My commission expires: a 6
Following approval please return this affidavit to the s Office.
Notary Public State of Arizona
Maricopa County
Marisa A Brito
My Commission Expires 07/0312017
SA.A."..W.AA/Vvi

LITCHFIELD ELEMENTARY SCHOOL DISTRICT
272 East Sagebrush Street Litchfield Park, Arizona 85340 623.535.6000 Fax 623.935.1448 www.lesd.lc12.az.us
'A Stronger Mind for a Stronger Future"
AFFIDAVIT APPRUVED
JULI 32016
DAT-
STATE OF ARIZONA
SS.
COUNTY OF MARICOPA } MARIGOPA COUNTY
A representative of Sounds Academy being first duly sworn, upon oath
deposes and says:
That on the 2th of May, 2016 she <he> presented to the Litchfield
Elementary School District # 79 of Maricopa County, for payment, a
claim for services rendered or supplies furnished during the month of Feb.,
March, April, 2016, said claim being in the sum of One Thousand Eight
Hundred and 00/00 Dollars ($1,800.00) in payment of which the
Superintendent of Schools caused Warrant No. 460098797 to be issued on
05/05/2016, drawn on the Fine Arts Contracted Instruction of Litchfield
Elementary School District # 79 of Maricopa County, Arizona.
Affidavit further states that although you were informed and believes that
the above mentioned warrant was regularly issued, the same has never
been received or has been lost, stolen or destroyed and has never been
deposited.
WHEREFORE, affiant prays that the Board of Supervisors order and the
Superintendent of Schools issue to Sounds Academy a duplicate of said
Warrant No. 460098797 in the sum of $1,800.00.
Payeaignature(---'
Subscribed and sworn to before me this :7-7\ LUfr(day of aCtlfr
RICHARD ROSE
Notary Pubic - State dAttaxia Notary Public
MARICOPA COUNTY
My Commission Explies
July 27,2016
My commission expires:
Following approval, please return this affidavit to Maricopa County
Superintendent's office.

Litchfield Elementary School District Mail - Affidavit Sounds Academy https://mail.google.com/mail/u/0/?ui=2&ik=4058c6e6a4&view=pt...
1.11(:111,111.1) l'ILNIENTARY Martha lain <iribe@lesd.k12.az.us >
SCII001. t)IST ItICI
Affidavit Sounds Academy
Kirk Johnson <kirk@soundsacademy.org > Thu, Jun 23, 2016 at 3:31 PM
To: Martha tribe <iribe@lesd.k12.az.us >
Hey Martha!
Thanks for checking in on this.
I actually got it notarized today and will forward you the copies.
Thanks,
Kirk Johnson
Kirk Johnson, Founder & Director
SOUNDS Academy
Students Opening Up New Doors with Strings
www.soundsacademy.org
(623) 349-4774
This communication and any file transmitted with it may contain information that is confidential, privileged and
exempt from disclosure under applicable law. It is intended solely for the use of the individual or entity to
which it is addressed. If you are not the intended recipient, you are hereby notified that any use, dissemination
or copying of this communication is strictly prohibited. If you have received this communication in error, please
notify the sender. Thank you for your cooperation.
Like tJASZn
[Quoted text hidden]
7/7/2016 8:46 AM
1 of 1