042016 DUPLICATE WARRANTS - 2.PDF

INTEROFFICE MEMORANDUM
91faricopa County School-Superintendent's Office
TO: CLEVC OE TOE 00ARCO
FROM: Willie Thompson
SUBJECT: Affidavits
DATE: 3/28/2016
Pase _find attached _1 Affidavit/Notice of Cfaim(s)for Cost warrants for inclusion on
the next availa6le 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 fiad a stop payment done.
If you have any questions, p&tse contact Millie 'Thompson at 506.3898 or via e-mad at
mthompson@mcesa.maricopa.gov . Approved Affidavits may he routed hack to the
Superintendent of School - finance Division at 4041 N. Central-Avenue #1200, ( 12 th
Efoor) Thankyou.
#79 LITCYMELD ARIEL ARIS9VIENVEZ $350.77
MARICOPi ANTY jPERVISORS
CLERK BOMO
\ 10. ux\i\Qu9

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.
Ariel Arismendez (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about (date)(2) a warrant/check was issued to the
above named persor(/entiW 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/che4 be issued to .him/her in the sum of $ 350 -77 .(3)
- II
Signed: C (4)
(5) Subscribed and sworn to before me this day of March 20 16
BRITTANY CARTER
Notary Public
My commission expires: Maricopa County, AZ
in' I ,q9. _ g‘olci My Commission Expires (seal)
April 29, 2019
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 1-6-0064218
(if known) (6)
Original Date of Issue 2/25/2016
(if known) (7)
Reason for original issue of Warrant/Check (8):
I* Payroll
El For Services or Goods furnished
LI 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

INTEROFFICE MEMORANDUM
Warkopa County School Superintendent's Office
TO: CLERX OE TOE 00ARD
FROM: Iliffie 'Thompson
SUBJECT: Affidavits
DATE: 3/28/2016
Pctse find attached _1 Affidavit/Notice of Claim(s)for lost warrants for inclusion on
the ne.2c-t available Ooard 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.
lf you have any questions, please contact 911iffie Thompson at 506.3898 or via e-mail at
mthompson@mcesa.maricopa.gov . Approved Affidavits may be routed 6ack to the
Superintendent of School - Finance Division at 4041 1I1: Central Avenue #1200, ( 12 th
'Floor) Thankyou.
#214 croLLEsoxviaax cll -T-oE GLENDALE SRO $5323.33
8 2016
)-)PI C
CLERK ,RD OF , DRS
opu,C.& a_4

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.
David Rice - City of Glendale SRO (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about March 16, 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 $ 5,323 . 33 .(3)
Signed: (4)
(5) Suli§cribed and Porn t? before me this day of Wja.A CA 20 ,'€'.
Acy
,X)
TARY PUBLIC
LINDA S. BERG
My coOmiss)on expires: Notary Public- Stater of Arizona
MARIOOPACOUNTY
tr40W6Z/L__ 2C/V My Emtember Cotnmission 4, Expires 2018 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 460069142
(if known) (6)
Original Date of Issue 2/2/16
(if known) (7)
PR O
Reason for original issue of Warrant/Check (8):
El Payroll
IR For Services or Goods furnished Copper Canyon's SRO
111 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

a memorandum from the
Glendale Police Department
Integriv a Courage a Excellence a Respect • Compassion * Dedication
DATE: March 28, 2016
TO: Henriette Cooper, Tolleson Union High School District #214
FROM: Denise Krause, Glendale Police Dept
SUBJECT: Missing check #214726876
I am a Senior Management Assistant employed by the City of Glendale. Among other
duties, I supervise David Rice who is responsible for billing and accounting for payments
in connection with the School Resource Officer (SRO) program. Mr. Rice has personal
knowledge of the facts relating to the SRO billing and is authorized to sign the affidavit
dated March 16, 2016, relating to a lost check for services rendered.