042016 DUPLICATE WARRANTS - 6.PDF

INTEROFFICE MEMORANDUM
Ilaricopa County School-Superintendent's Office
TO: CLERK OE TYPE BOARD
FROM: Willie 'Thompson
SUBJECT: Affidavits
DATE: 4/4/2016
Prease find attached 2 Affidavit/Xotice of Craim(s)for Cost warrants for incrusion on
the next avada6k Ooard agenda
(The attached item(s) have 6een researched to ensure that the warrant(s) in
question have not 6een cashed or previous& re-issued
4 'The originaf warrant (s) have had a stop payment done.
If you have any questions, prease contact Maw Thompson at 506.3898 or via e-mad at
mthompson@mcesa.maricopa.gov . Approved Affidavits ma y he routed hack to the
Superintendent'Of School finance Division at 4041 X. Central - Avenue #1200, ( 12 th
Efoor) Thankyou.
#45 EOWLER DANIELLE BLAU $78.49
#79 LITCJITIELD BERNADE'lelE .7 -COLWES $ 282.65

Schools Affidavit/Claim Form 14)
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.
Danielle Blake (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 7_,/2 (0/20 I to (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 $ 78 .49 .(3)
t,
Signed: (4)
bscribed and-sworn to before me this day of 20
OFF1 IAL SEAL
My commission expires: *- " Notary BARBARA Public M.GILL - Arizona
Aki .P-011 "0 d%'. \I • 7: - - MARICOPA COUNTY 2E0x1p9ires (seal)
14:400,01 My CommsisTsilo4n
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 Warrant# 160064787 Check# 45214186
(if known) (6)
Original Date of Issue 02/26/2016 —
(if known) (7) ,C.\ V) M , - - i-il
Reason for original issue of Warrant/Check (8):
Payroll
III For Services or Goods furnished K, MARICOPA BOARD OF COUNTY SUPERVISORS
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

/1 c\.
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.
- erna(te 14/._/ kpitY16 (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 31 3111 (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 issped to him/her in the sum of $ (95 .(3)
Signed: (4)
(5) Subscribed and sworn to before me this day of rn6u-c,k) 20
;)
e671
RITTANY CARTER
Notary Public
Maricopa County, AZ I
My commission expires: My Commission Expires
nprd ,q1 gni q April 29, 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 Up0067).-g7
(if known) (6)
Original Date of Issue 3/ 1° Ii
if known 7 (0
Reason for original issue of Warrant/Check (8): 0 5 201G
LI Payroll
LI For Services or Goods furnished
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