060816 DUPLICATE WARRANTS - 2.PDF

INTEROFFICE MEMORANDUM
Waricopa County School -Superintendent's Office
TO: CLERKOE TOE (B0AW9)
FROM: gfraffie 'Thompson
SUBJECT: Affidavits
DATE: 5/11/2016
(Please _find attached 1 Affidavit/Notice of Claim(s)for Cost warrants for inclusion on
the next available oard 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.
f you have any questions, please contact Wale 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 N. Central - Avenue #1200, ( 12 th
Efoor) Thankyou.
#1 PHOENIX EL VIRGINIA LVEM $616.37

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.
VIRGINIA LUERA (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 5. oci 70 1 (0 (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/chpck be issued toihim/her in the sum of $ 616.37 .(3)
Signed: __11 (4)
(5) Subscrilld and sworn to before me nthis 9R\ day of 1\461 20 \ .
May\ 0 C., (ZO
NOTARY PUBLIC MARla C. RgNiafiCY
Notary Public - Atizortia
My commission expires: Maricopa Expires 09/15/201T County
9 , 1S-Zol9- (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 16 0076818
(if known) (6)
Original Date of Issue 04/28/16
(if known) (7) 1
Reason for original issue of Warrant/Check (8): DATV WU 4
l4t Payroll
111 For Services or Goods furnished LOST I r-E-RK MAP'ICCPA BOARD OF COUNTY SUPERVISORS
Other: LOST
SAPROCESSES\Warrants Revised June 2015 - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc A.R.S. 11-632 & 15-999