062216 DUPLICATE WARRANTS - 7 - SCHOOLS.PDF

INTEROFFICE MEMORANDUM
Waricopa County ScfioorSuperinteneent's Office
TO: CLER7(0E 00ARD
FROM: Willie 'Thompson
SUBJECT: Affidavits
DATE: 6/7/2016
Pase _find attached 2 AffidavitOotice of Claim(s)for Cost warrants for inclusion on
the next availahle 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 (s) have had a stop payment done.
If you have any questions, please contact Millie Thompson at 506.3898 or via e-mail at
mthompson@mcesa.maricopa.gov . Approved Affidavits may he routed 6ack to the
Superintendent of School 'Finance Division at 4041 X. CentratiAvenue #1200, ( 12 th
'Floor) Thankyou.
#1 Of0ENIXELEM DLI SERVICES' LLC $1120.00
#1 010E9VIX ELEgil 7(,-12 MASCOTS $394.94
VED
JUN 0 9 2016
CLERK
YARD OF SUPERVISORS
vhfut,10

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.
DLI Services, LLC (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 05/09/2016 (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/che, be issu d to hi /her in the sum of $ 1120.00 .(3)
Signed: JJ J7144401, (4)
(5)1S.ubscribed and sw,cq-n to before me this dayof 3-U0C 20J,.
-COMMONWEILTIMPENNSVOW
NOTARY PUBLIC NOTARIAL SEAL
DONNA 0 SIMPSON
My commission expirets: MANHEIM TWP, Notary LANCASTER Public COUNTY
46,00=c D19/.Ropq My Commission Expires Feb 9, 2019 (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 460099523
(if known) (6)
Original Date of Issue 05/09/2016
(if known) (7)
Reason for original issue of Warrant/Check (8):
111 Payroll
• For Services or Goods furnished
ID 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

DLI SERVICES, LLC
6/6/2016
Phoenix Elementary School District #1
Attn: Rosalind Roberson
1817 N. 7th St.
Phoenix, AZ 85006
Dear Ms. Rosalind,
As CEO of DLI Services, LLC, I hereby give Mrs. Sarah Carranza permission to sign the provided
affidavits to reconcile payment for services due.
Sincerely,
(le/VOA/Pr
Sarah Carranza
Founder & CEO
DLI Services, LLC

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 MA ICOPA Instruction sheet which is page 2 of this form.
K-12 Mascots X 4 1)24 (1), being first sworn, upon oath deposes and says:
Name/Claimant 1
On or about 4" ig (date)(2) a warrant/check was issued to the
above named per on/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, uri r penalty of perjury, claimant hereby affirms that this claim is correct
and the aryibunt shown ikdue and owing, and the applicant requests that a replacement
7
warrant/ ued to him/her in the sum of $ 394 . 94 .(3)
Signed:
44b - irdz
(5) Subscribed tire me this day of jwvt%, 20A_.
NOTARY PUBLIC
NOTARY PUBLIC
KURT E SPAHRMANN
My commission expires: ';/ State of Texas
/2 ;2o/7 I • • Com1112111191119-0 I I 1 I I I 1 • IT I Exp 0511212017 (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 460092831
(if known) (6)
Original Date of Issue 4/18/2016 APPROVED
(if known) (7)
Reason for original issue of Warrant/Check (8): DAT
0 Payroll
RK, BOARD OF SUPERVISORS
II For Services or Goods furnished MARICOPA COUNTY
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

• RECEVED
JUN 06 2016
ACCTS. PAYABLE
2229-A Santa Anna Avenue
Dallas, TX 75228
(888) 802-3522
kl2mascoi sllc?a,gmail.com
www.k-12mascots.com
June 2,2016
Phoenix Elementary School District #1
Attn: Rosalind Roberson
1817 N. 7th Street
Phoenix, AZ 85006
Dear Ms. Roberson:
Please be advised that Alfred J. "A.J." Durtschi as the company business manager has my authorization to
sign any and all documents necessary for the Application for a Duplicate Warrant/Check.
Thank you.
Sincerely,
011: 6
Doris A. Liesenfelt
Owner