050416 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: 4/6/2016
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.
#201 Buckeye Union Canyon State Bus Sales $4198.80
2U1S

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.
Carwicni-akialts Wes (1), being first sworn, upon oath deposes and says:
Nam /Claimant
On or about 1 /5/201 Co (date)(2) a warrant/check was issued to the
above named perso /en ity 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 $4,198.80 .(3)
Signed: (4)
(5) Subscribed and sworn to before me this (>29 day of Maroi,\ 20 .
NOTARY PUBLIC
SARAH BROWN
My commission expires: Notary Maricope Public,Stste County of Arizona
i My Commission Expires (seal)
June 16,2017
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 460058679 APPROVED
(if known) (6)
Original Date of Issue 1/5/2016 DA! 701
(if known) (7)
Reason for original issue of Warrant/Check (8): RK BOARD OF SUPERVISORS
El Payroll MARICOPA COUNTY
IR For Services or Goods furnished repair and or supplies to transporatation dept
0 Other: repair and or supplies to transporatation dept
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of cialm.doc
Revised June 2015 A.R.S. 11-632 & 15-999

CMKUCODH TIT=
MUM 7i.Z.LLEEZ
March 31, 2016
Denise Weihe
Maricopa County education Service Agency
4041 N. Central Avenue, Suite 1200
Phoenix, Arizona 85012
This will confirm that Nhora Vega is the Accounts Receivable Administrator for this company.
In this position she is authorized to sign the SCHOOL AFFIDAVIT/CLAIM FORM dated March 29,
2016, which referenced check # 460058679.
Please feel free to contact me with any questions or concerns.
Sincerely,
B. Cris Harrop CPA Controller
3113 West Weldon Avenue, Phoenix, Arizona 85017 • Phone 602-230-1515 • Toll Free 1-877-230-1515 • Fax 602-230-1519