062216 DUPLICATE WARRANTS - 4 - SCHOOLS.PDF

INTEROFFICE MEMORANDUM
gilaricopa County Education Service Agency
TO: Cferkof the Ooard
FROM: ELSA PEREZ
SUBJECT: Affidavits — Rcpfacement of Lost /StaTh Warrants
DATE: 6/3/201 6
Please find attached AffidavitOotice of Claim(s)for Cost warrants for inclusion on
the next avaifa6 Ooard agenda.
"\I The attached item(s) have 6een researched to ensure that the warrant(s) in
question have not 6een cashed or previously re-issued
The originaf warrant(s) have had a stop payment done.
If you have any questions, please contact ELSA PEREZ at (602) 506-3533 or via e-
mad at garnishments@mcesa.maricopa.gov. ApprovedAffidavits may he routed 6ackto
the Waricopa County Education Service Agency at 4041 SIV Centraf Avenue #1200, (
12th Eloor) Thankyou.
'Fund 781
Socorro Castillo 160086651 $515.07
JUN 0 6 2016
CLERK,BOAt (:)= UPRVISOR
/() LANAL-L.-&-

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: g 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.
SOCORRO CASTILLO (1), being first sworn, upon oath deposes and says:
Name/Claimant
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 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 $ 515 .07 .(3)
Signed: (3cc., u Co,c4A0 , (4)
Note: Please attach 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 day of1C(AN€ 201 (e.
NOTARY PUBLIC
Notary Public State of
My commission expires: Marl Doris copa Ruvo County •
LD- My Commission Expires OE:0 1*M: (seal)
Warrant/Check Number 160086651
(if known) (6)
Original Date of Issue MAY 26, 2016
(if known) (7)
Reason for original issue of Warrant/Check (8):
Payroll
O For Services or Goods furnished
O Treasurer's refund/payment
O Other:
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc
Revised April 2015 A.R.S. 11-632 & 11-644