060816 DUPLICATE WARRANTS - 1.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: 5/6/2016
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.
#401 EVIT Jamy Scrubs LLC $312.00
#60 Higley Robert Eulate Gonzalez $76.84
ED
MAY 0 9 2016
,iCOPA ',CANTY
CLERK BOARD OF SUPERVISORS
170 ,Aywa

dt\
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.
Jamy Scrubs LLC (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about Jan 28-2016 (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 $ 312.00 (3)
Signed: (4)
Notary MARY Public,Slate R. BECK of Arizona
Maricopa County
My Commission Expires
) 5 I March 15, 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 460067296
(if known) (6)
Original Date of Issue 01/28/2016
(if known) (7)
Reason for original issue of Warrant/Check (8):
0 Payroll
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

Jamy S onu s
April 28, 2016
To whom it may concern:
I, Jamie A Standage, am authorized to sign on behalf ofiamy Scrubs regarding all business bank
accounts.
Jamie A Standage, CPA
Janny Scrubs

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.
Robert Eulate Gonzalez (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 71/ 0/.,7201.13 (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 $ 76.84 .(3 )
Signed: (4)
(5) Scribed and sworn to before me this (141111 day of Mal 20
OFFICIAL SEAL
My cyyssion. expires: Notary TAMMY Public - State NAVARRO of Arizona I
5 MARICOPA COUNTY (seal)
My Comm. Expires March 6, 2019J
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 160001308
(if known) (6)
Original Date of Issue 7/10/2015
(if known) (7)
Reason for original issue of Warrant/Check (8): rtiiY 10 2016
Payroll
41.11X?
0 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