062216 DUPLICATE WARRANTS - 6 - SCHOOLS.PDF

INTEROFFICE MEMORANDUM
Waricopa County School -Superintendent's Office
TO: CLERX OE TOE 00ARD
FROM: fMilTie 'Thompson
SUBJECT: Affidavits
DATE: 6/6/2016
(Please find attached 1 Affidavit/Xotice of Claim(s)for Cost warrants for inclusion on
the next available Ooard 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, p lease contact Millie Thompson at 506.3898 or via e-mail at
mthompson@mcesa.maricopa.gov . :Approved Affidavits may be routed back to the
Superintendent of School Finance Division at 4041 X. CentrarAvenue #1200, ( 12 th
Floor) Thankyou.
#214 TOLLESON -1)91110X NA GC/ANDREW OASSEver $518.00
JUN 0 7 2015
MAR - 6UNTY
CLERK N. BOARD 0:
1/6 (_,A(Y•X

Schools Affidavit/Claim Form
Application for a Duplicate Warrant/Check (definitions are on page 2)
ilittiii tzt: )c—A-1,_1:-_:, rk
STATE OF Note: Numbers on this form correspond to numbers on the
COUNTY OF-MAgles7eiRik Instruction sheet which is page 2 of this form.
viv1, / -K1, -7- nk_ -c-i:
Andrew Bassett ;c:.A C.- (L. (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about April 14, 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 $ 518.00 .(3)
e_z_eher)
My commission expires:
August 2, 2017
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 460046859
(if known) (6)
Original Date of Issue 11/24/15 i i _ -;,,2 ri- , IT
(if known) (7) : .
Reason for original issue of Warrant/Check (8):
El Payroll
K. BOARD OF SUPERVISORS
gl For Services or Goods furnished2015 NAGC Convention MARICOPA COUNTY
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

National ..kssociation for Gifted Children
NATIONAL Gine chim ACSOCIA HON p , 1 NW wt t no 1
................. 1)C.
2.02/7E:5- 12f.;1
FaN 201' /
June 6,2016
Via E-mail
Attn: Henrietta Cooper
Tolleson Union High School District #214
Dear Ms. Cooper;
Andrew Bassett, Director of Finance for the National Association for Gifted Children has the
authority to sign documents on behalf of the organization.