Extracted text (via pymupdf_layout)
7010 characters
INTEROFFICE MEMORANDUM Maricopa County Education Service Agency (aka Maricopa County Superintendent of Schools Office) RECEIVED TO: CLERK OF THE BOARD FEB 1 9 2016 FROM: Denise Weihe MARICOFA CCL%sITY SUBJECT: Affidavits — Replacement of Lost Warrants CLERK BOARD OF SUPERVISORS DATE: 2/18/2016 iir 4116 Please find attached 3 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. #9 Wickenburg Margot Spiker/ASA, Inc $660.00 #214 Tolleson Union Martin Alejandro Moreno $19.97 #66 Roosevelt Armando Chavez $55.68 #31 Balsz Mohamed Muhemed $484.10 APPROVED DAT FEB\ 1 9 2016 K GOAR CT-CIF S MARIGO PA COUNTY WICKENBURG UNIFIED SCHOOL DISTRICT NO. 9 40 W. Yavapai, Wickenbur g AZ 85390 Phone (928) 668-5350 Fax (928) 668-5390 CH A MPIONS - FOR - CHILDREN AFFIDAVIT V'°'' 1 Sd6-100L- /Al loARG-or6 -p ike-1C being first duly sworn, upon oath deposes and says: 15* That on thelaii. day of„bwer4e# 20.g he presented to Wickenbur g Unified School District #9 Maricopa County, for payment, a claim for services rendered or supplies furnished durin g the month of SA N AO I t said claim being the sum of _Q/94,4,441/44 Dollars (*Ala, in payment of which the Superintendent of Schools caused Warrant # 4600_54q.757_ to be issued on M..ec.odoet Is- , 201T , drawn on the .001 fund of Wickenburg Unified School District #9 of Maricopa Count y, Arizona. Affiant further says that although he was informed and believes that the above mentioned warrant was regularly issued, the same has never been received, or has been lost. Wherefore, affiant prays that the Board of Supervisors order and the Superintendent of schools issue to him a duplicate of said Warrant #464951103-in the sum of $ Woo. As Signature: ./ , Subscribed and sworn before me this day of -Feb, ,20 di 7(idiez Notary/Signature' Commission tunranon Date CHANDYCE ANDERSON Notary Public - Arizona Maricopa County My Comm. Expires May 7, 2019 grgi Following Notary approval please return original affidavit to: Wickenburg Unified School District Accounts Payable 40 W. Yavapai Street Wickenburg, AZ 85390 .4 FFIDAVIT APPROVED DATEA_ FEU 92 STATE OF ARIZONA K, BOARD OF SUPERVISORS COUNTY OF MARICOPA MARICOPA COUNTY qarli A1e3a/110 being first duly sworn, upon oath deposes and says: That on the d.VIciday Oi 20 Ile , he presented to 7-6;Itesw ankvi lig District of Maricopa County, Arizona, for payment, a claim for services rendered or supplies furnished during the month of tilt tit r(7 20 , said claim being in the sum of pItte-4-e-44 V(tL q/1107)Doliars, ($ tcreri ) in payment of which the Superintendent of Schools caused his/her Warrant Number HeODA-z,,c-5--g to be issued on , 20 ge, drawn on the ()Of Fund of el ollesoyi Upft,v, ll-s , District of Maricopa County, Arizona. Affiant further says that although he/she was informed and believes that the above mentioned warrant was regularly issued, the same has never been received, or has been lost. WHEREFORE, affiant prays that the Board of Supervisors order and the Superintendent of Schools issue to him/her a duplicate of said Warrant Number be)bc6A-G in the sum of $ 0 7 kliAA Signed: AA Subscribed and sworn to before me this day of ,20 JOYCE C. COUNCIL d Notary Public- State of Afton MARICOPA COUNTY My Commission Expires Sept It 2017 NOTARY PUBLIC My commission expires: 02/ Following approval please return this affidavit to the Maricopa County School Superintendents Office. 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. Armando Chavez (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 2" 96 120(5- (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/ch7k-be-i-sved to h 12‘.- in th s)1Jm of $ 55 . 68 .(3) Signed: (4) ( ribed and" sworri before me this day of rebr00-1(1.. 20 /1.P . AP6' PUBLIC Notary Public State of Arizona Mancopa County My comlylissi9n expires: My Raquel Commission Robles Expires 0710312017 0 7/03 .9N7 (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 15-00595 18 (if known) (6) Original Date of Issue 2/25/2015 (if known) (7) Reason for original issue of Warrant/Check (8): 0 Payroll For Services or Goods furnished 6 PNT-tr- K, MARICOPA °ARO (It COUNTY SUPriggiS ORS lii 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 AFFIDAVIT APPROVED DATEA EaL9A16 STATE OF ARIZONA , 13r5ARb tlf4 COUNTY OF MARICOPA MARICOPA COUNTY * ANifif4e-2) 9 iitovivi,E2), being first duly sworn, upon oath deposes and says: (name and title of person )* That on the /6 day of ig-25,ea4-47' 20 /6 , he/she presented to eifk-S Z%/ District of Maricopa County, Arizona for payment, a claim for services rendered or supplies furnished during the month of /Wniee.--/-/- 20 /5- , said claim being in the sum of ($ 48s. Jo ) 15.mjittAil),-27-ak.7--k4e.pr 1%2.1.4 Dollars in payment loA c)04,4,459 Which the Superintendent of Schools caused his/her Warrant Number 3//41-0/46A to be Issued on the /57-drawn on the a9/ Fund of /(1 District of Maricopa County, Arizona. Affiant further says that although he/she was informed and believes that the above mentioned warrant Was regularly issued, the same has never been received , or has been lost. WHEREFORE, affiant prays that the Board of Supervisors order and the Superintendent of Schopls issue to him/her a duplicate of said Warrant Number ..3/6/41-012,01 in the sum of $ 44 . Signed:** (Name & title of authorized personnel)** Subscribed and sworn to before me this /4' day of , 20 /4 NOTARY PUBLIC : - URIE M. COLTER NOTARY Pusuo -ARIZONA MARICOPA COUNTY My commission expires: MvCommlealon Expires Wet) 29, 2019 Following approval please return this affidavit to the Maricopa County Education Service Agency Office.