DUPLICATE WARRANTS - 2.PDF

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Human Resources |
2015 JANI 1 PM 3:06
Madi vidval
ale
VMemo
To: Fran McCarroll, Clerk of the Board
From: Wanda Childers
Date: January 11, 2016
Re: Replacement of Lost Payroll Warrants
Please find attached _1__ Affidavit/Notice of Claim(s) for lost
payroll warrants for inclusion on the next available Board 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.
Please call Wanda at ext. 60409 for any questions. Please route
approved Affidavits back to County Payroll, Suite 220.
Stale Dated Warrant Duplicate Warrant
Thank you.
.
Replacement Lost Warrant Form 1 02/25/2015

Application for a Duplicate or Stale-Dated Warrant/ Check
Affidavit/ Claim Form
This application is for: {mm Duplicate or LJ stale-Dated (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.
SALLY MAE HUFF (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 11/18/2015 (date)(2) a warrant/check was issued to the
above named person/entity in the amount as stated belo Such warrant/check was
either never received or was subsequently inadvertentl¥ lost gr 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
115.00
be issued to him/her in the $ (3)
a)
Signed: Nab uff (4)
fe
Ghach Aorant/check
Note, Please a copy of the if available and/or any other
evidence that a warrant/check was originally issued.
(5) Subscribed and sworn to before me this __C| day of etal aval 20 1.
;
iba
N
aan
MARICOPA COUNTY
Commission Expires
My commission expires: August 24, 2019
Auaust oY ON (seal)
Warrant/Check Number
22330929
(if known) (6)
Original Date of Issue
Reason for original issue of Warrant/Check (8): > ai 20
lm Payroll S =
LO For Services or Goods furnished “2 co FT
QO Treasurer’s refund/payment Sp
CO) Other: oa =
Revised April 2015 ARS Pot Dey IE LD
PACOUNTY _

ME GurisalyMae-mcteLe
( Paycheck View ( MCY-Eamings [ Taxes { Deductions & Garnishments it Special Accumulators if Distributions
Name Huff,Sally Mae Confirmed Check
| Check# Issue Date Earnings Taxes Deductions Net Pay
| 22330929 11/18/2018 Pn =— «15.00
~ Reqularand Overtime Earnings ~~ : pop ~ Taxes
~ OtherEarnings ~ Deductions
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ADP Enterprise HR screen print as of: 01/11/2016 02:14 PM

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: 1/12/2016
Please find attached 2 Affidavit/Notice of Claim(s) for lost warrants for inclusion on the
next available Board agenda
Vv The attached item(s) have been researched to ensure that the warrant(s) in
question have not been cashed or previously re-issued.
Vv 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 Schools Finance Division at 4041 N. Central Avenue #1200.
#216 Agua Fria Alisa Needler $765.00
#65 Littleton Ann-Jeannette Estrada $1394.50
JAN LB 2046
oy MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS
[i |
mar
0

Uo
oe
+
FE i x aD
Ny Stop Payment
|
STATE OF ARIZONA
i
COUNTY OF MARICOPA
— ae
FIMO Oe ~ ~JEA Lea. ODS vane Lhe a La fi
bre SHO Om A
being first duly sworn, upon oath deposes and
states:
That on the i day of SIGN UGCA UL IG
,20 , he/she presented to Littleton
Elementary
School District No. 65, of Maricopa County, for
payment, a claim for services rendered
or supplies furnished during
the month of IOC ek
said claim being in the sum of Uae Shousiocl Whee Wurcck wash
C u —— AN ALAS
Dollars ($ 1384.0 ) in of * SU/i6q —
payment which Littleton Elementary School District No.
65 caused warrant/check
number Li 00 349730 Xt
to be issued on day of WOO0VC wera a
,20_ (5
drawn on the warrant/check fund of Littleton
Elementary School District No. 65 of Maricopa
County, Arizona.
' “ant further states that
although he/she was informed and believes that the above
mentioned warrant/check
was regularly issued, the same has never been
received, or has been lost.
Wherefore, affi ant requests that the
Governing Board order and the Littleton
Elementary School District No. 65 issue
to him/her a replacement of said warrant/check number | OC 34 130
in the sum of $ Jacq. 50
Stanatffe }
Subscribed and sworn before me this Ke
day of NAHUCYY
201@_.
LL
ELBA M. LOZANO
_eemeatr
November 27, 2017 | Noemie S77 3017
My Commission Expires
03/2013

OY
STATE OF ARIZONA
COUNTY OF MARICOPA
AVISA NEEDLE _, being first duly sworn, upon oath deposes and says:
That on the _1\ day of JAN 20 1p, he presented to AFUHS D 2 Ilo
District of Maricopa County, Arizona, for payment, a claim for rendered
services
Or supplies furnished during the
month of DEC | 20|5, said claim being in the sum of
SEVEN WUNNCED ($715.8) in payment of which the
potlars,
eae saused
Superintendent of his/her Warrant Number 4420055497 tobe
issued on DEC.1{ _, 2015. drawn on the 52le Fund of -AFURSD “sic,
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
ALQOESGT] _ in
Signed: Lede 7/7:
LZ.
Subscribed and Sworn to béfore me this Ta
day le 20 Le
a
Sere 2 Conk | oe sant 3 E CONTRERAS
tay 2 Bumic ae. t
My commission expires: 4 = DH NOTARY: ee BENG: KAARICOPAC ARICOPA COUNTY 3
i, gun 24, 2042
peed ew eT ee
Following approval please retum this affidavit to the Maricopa County School Superintendents Office,

INTEROFFICE MEMORANDUM
Maricopa County School Superintendent's Office
TO: CLERK OF THE BOARD
FROM: Millie Thompson
SUBJECT: Affidavits
DATE: 1/11/2016
Please find attached _1 Affidavit/Notice of Claim(s) for lost warrants for inclusion on
the next available Board agenda
\ 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 Millie 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
Floor) Thank you.
#201 BUCKEYE UNION BUCKEYE WATER, RESOURCE DEPT $12916.35
JAN 2 8 2016
MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS
i/o mat alt

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.
ce AC Be Udder ar x¢2 (1), being first sworn, upon oath deposes and says:
am ma
On or about “ (Ye c {20'S (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 $ LA. A “i (3)
|
B LO WWIEs
signed: Hua (4)
(5) Subscribed and sworn to before me this lp day of _cf a Nn 20_/(
2.
Naacee, Caye.
NOTARY PUBLIC
NANCY LOVE
My commission expires: Notary Public. State of Arizona
Maricopa County
Jan 29/@ 7 My Commission Expires
January 31, 2018 (seal)
Note. Please attach a copy of the warrant/check if available and/or other
any
evidence that a warrant/check was originally issued,
Warrant/Check Number
(if known) (6) YOLOYS 2/7
Original = Date of Issue - \ \
(if known) (7) fal 1 [ac S~ NAAR j
w \
y= PA
Reason for original issue of Warrant/Check (8): Na 4M
O Payroll \\) vi
\ WY \
( For Services or Goods furnished ' it \ )
Other: Wales Gevorces OAV
Pay)
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of clalm.doc
Revised June 2015 A.R.S. 11-632 & 15-999

THIS DOCUMENT CONTAINS A TRUE WATERMARK - HOLD TO LIGHT 70 VIEW
‘SCHOOL EXPENSE WARRANT fh Morgen Chase Bank, N 2
===
OF MARICOPA COUNTY © ai hemes
TREASURER 5 aa
12/01/2015 201612134 |
.
‘
Buckeye Union High School District #201 ;
_. | WARRANT AMOUNT i
AY $12,916.35
“Twelve Thousand Nine Hundred Sixteen and 36/100*** Dollars i
:
VOID 365 DAYS
BUCKEYE WATER RESOURCES \
)
IE P.O, BOX 52747 \oney
8 Hen, 5
3DER PHOENIX, AZ 85072-2747 Dr. Donald Covey
: A 3 Superintendent of Schools i
Kol AUTHORIZED SIGNATURES ¢
_ .
7m @keckOOOckn QVPOIdLaa"
MLBOOLA2aa
42/01/2015 Check: 201612134 EXPENSE
ARICOPA COUNTY SCHOOLS « PHOENIX, ARIZONA AP Run Date 12-2-2015 460048217
BUCKEYE WATER RESOURCES | | 12/01/2015 _| |
Payee | | Check Date | |
Account Number PO Number Invoice Amount
_
001180261064 115100000000 180342 = 1091034.4 354.94
001160261054 115100000000 180342 9 -1104774.4 4,061 18
001160261064115100000000 460342 1104779.4 633 89
001180261004 115100000000 180342 = 1109499 4 4,638.18
00116026 1064 115100000000 160342 1109504.4 9,884.75
001160281064 115100000000 160342 = 1137094.4 1,479.93
0011860261064115 100000000 160342 1937104.4 274 27
AAI IRNORI OR ATI RIANA ARNU7 = 11RART A ABB 20.

aon
CITY OF BUCKEYE
BUCKEYE, AZ
DEPARTMENT NAME
City of Buckeye
Water Resources Department
January 11, 2016
To whom it may concern:
The affidavit for the Buckeye Union High School District documenting the
disposition of the warrant for payment of the utility bills to the City of
Buckeye was signed by the Utility Billing Supervisor, Robyn Jacobs.
She has the authorization to sign the document presented.in regards to the
warrant presented.
City of Buckeye Water Resources Department
530 E. Monroe Ave. » Buckeye, Arizona 85326
Phone 623-349-6200 * Fax 623-349-6222 « www.buckeyeaz.gov