062216 DUPLICATE WARRANTS - 10 - SCHOOLS.PDF

INTEROFFICE MEMORANDUM
Maricopa County Education Service Agency (aka
Maricopa County Superintendent of Schools Office)
TO: CLERK OF THE BOARD
FROM: Denise Weihe
SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 6/14/2016
Please find attached 2 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.maricopa.gov . Approved Affidavits may
be routed back to the Superintendent of School Finance Division at 4041 N.
Central Avenue #1200, (12th Floor) Thank you.
#45 Fowler Jose Estrada $77.16
#214 Tolleson Union Kendall Hackney/GCU $450.00
RECEIVED
JUN 1 5 2016
MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS
/0 VYYkLe CL.196

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.
Jose Estrada (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 02/26/2016 (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 $ 77 - 16 -(3)
Signed: _6(17Z- (4)
(5) Subscribed and sworn to before me this ci4k\ day of „AwHe._ 20 IQ .
OCk) Ica,
NOTARY PUBLIC
My commission expires: Notary Marboos EDITFI Public DUARTE County - Arizona
0-W1V My Dammilmr Commission 13, Expires 2011 (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 45214245
(if known) (6)
Original Date of Issue 02/26/2016
(if known) (7) Ivgi 0 Lii la,
Reason for original issue of Warrant/Check (8):
HHHHIH
For Services or Goods furnished
LI Other:
SAPROCESSES\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.
OLA I fiTt (1), being first sworn, upon oath deposes and says:
ame/Claimant e,y-) 's BA,Q,Korbet,ii
On or about June 2, 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
ued to hjm/her in the sum of $450.00 .(3)
Signed: (4)
(5) Subscribed and sworn to before me this day of Tt( /1-C 20/ .
_e( QZQ
NOTARY PUBLIC
Notary Public State of Arizona
My commission expires: Maricopa Kathleen Ann County Hall
My Commission Expires 01/04/2020 (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 460098075/214729213
(if known) (6)
Original Date of Issue 5/3/16 — A IP — P ,-,
(if known) (7)
Reason for original issue of Warrant/Check (8):
LI Payroll
CLERK BOARD OF SUPERVISORS
111 For Services or Goods furnished MARICOPA COUNTY
2Other: &C t& W"YleAr' r3 g 14+-e-1143- Team, cit,n-r ?vim/It-At
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

ECU
ATHLETICS
To Tolleson Union High School District or To Whom It May Concern,
I, Kendall Hackney, am authorized to sign this affidavit. I am the director of basketball
operations for women's basketball here at Grand Canyon University. I am the individual
receiving payments for our summer basketball camps. I get notified when payment is received
or I am the direct recipient of the payments for camp, depending on the avenue each school
pays (check, credit card online, etc.). I also keep a log of payments received to ensure that all
payments are accounted for.
If there are any questions regarding my authority in signing this affidavit, you can contact the
GCU athletic department employees below for verification:
Tyneshia Johnson — Business Operations - TyneshiaJohnson@gcu.edu - (602) 639-8749
Theon Carrier — Director of GCU Camps — Theon.Carrier@gcu.edu — (602) 639-6942
Sincerely,
Kendall Hackney
Director of Basketball Operations, Women's Basketball, Grand Canyon University
GCULOPES.com 0000
3300 WEST CAM ELBACK ROAD I PHOENIX, ARIZONA 85017 I 602-589-2300 I TOLL-FREE 800-800-9776 I GCULOPES.COM