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INTEROFFICE MEMORANDUM Maricopa County Education Service Agency (aka Maricopa County Superintendent of Schools Office) TO: CLERK OF THE BOARD FROM: Denise Weihe JAN 0 2016 SUBJECT: Affidavits — Replacement of Lost Warrants MARICOPA COUNTY CLERK BOARD OF SUPERVISORS DATE: 1/19/2016 I ib Please find attached 7 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. #5 Isaac Naydar Laureano $965.73 #401 EVIT Aztec Specialty Produce $149.53 #95 Queen Creek Krissy Hodges $305.91 #2 Riverside ; DeEllen L Stowell $1249.77 #44 Avondale Ella Willis $1035.72 #44 Avondale Jacob Davis $403.65 #79 Litchfield Ana Lilia Martinez $926.37 APPROVED -0b DATA 1ANA2 1 1 Schools Affidavit/Claim Form RK. BOARD OF SUPERVISORS MARICOPA COUNTY 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. \-15S9 HCC1Y6 (1), being first sworn, upon oath deposes and says: Name/Clatraant On or about / 1 2- 3 I (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 $ .(3) Signed: (4) (5) Subscribed and sworn to before me this D...441 day of 20 NOTARY PUBLIC 11.•IIII••I••I•I.156,10.1......1. LORI ANN PLATES Notary Put9c- State ciArtataa My commission expires: MARICOPA COUNTY My Commission Explrea 57 A/ May 2, 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 (if known) (6) t(1000013S--- Original Date of Issue i . (if known) (7) li(2-3//C Reason for original issue of Warrant/Check (8): 'V, Payroll Ill For Services or Goods furnished El 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 STATE OF ARIZONA N 2 1 2016 COUNTY OF MARICOPA ERK, BOARD OF SUPERVISORS MARICOPA COUNTY \Joa.--t) being duly sworn, upon oath deposes and says: That on the day of Fl V, Utc."6-jr. , a0(5 he/she presented to the Avondale Elementary School District of Maricopa County, for payment, a claim for services rendered or supplies furnished during the month of (:)Veg- , 1(.2) , said claim being the sum of -Four ...1uratExt.44vva 4.-(41((r dollars ($ t3 .(P ) in payment of which the Superintendent of Schools caused his/her Warrant Number 9c001 to be issued on CrAkt4 34) , GO(5 , drawn on the CJC Fund of Avondale Elementary School District of Maricopa County, Arizona. Claimant further says that although he/she was informed and believed that the above- mentioned warrant was regularly issued, the same has never been received or has been lost. Under penalty of perjury, claimant hereby affirms that this claim is correct and the amount shown is due and owing. Wherefore, claimant requests that the Board of Supervisors order and in the Superintendent of Schools issue him/her a duplicate of Warrant Number 0t 007 I in the sum of $ L103 (05 Claimant Signature Subscribedand sworn ore me this /EV17 day o , cad 6 . efeZ rdet My commission expires: atyail .//,,2a Notary Public) Seal: OFFICIAL SEAL LAURA VERA Notary Public - State of Arizona MARICOPA COUNTY My Comm. Expires Aug. 31, 2017 Following approval please return this affidavit to Maricopa County Education Service Agency APPROVE III -(e\ DARE JA 21 Schools Affidavit/Claim Form ERK, BOARD OF SUPERVISORS MARICOPA COUNTY Application for a Duplicate Warrant/Chetk (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. Ana Lilia Martinez (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 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 $ 926 - 37 .(3) Signed: 4044_ (4) (5) Subscribed and sworn to before me this i3 day of ,A-(n ()col 20 1& . 1,1 • NOTARY-PUBLIC BRITTANY CARTER Notary Public My commission expires: Maricopa County, AZ April My Commission Expira I) Aoril 29. 201q 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 160051418 (if known) (6) Original Date of Issue 12/31/2015 (if known) (7) Reason for original issue of Warrant/Check (8): • Payroll D For Services or Goods furnished El 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 I STATE OF ARIZONA DA3/ JA142 1 20j COUNTY OF MARICOPA PI'K, BOARD OF SUPERVISORS - MARICOPA COUNTY E& Wt being duly sworn, upon oath deposes and says: That on the a LI 141 day of Z),Ec...c-_-,rnbc.- It , @VS he/she presented to the Avondale Elementary School District of Maricopa County, for payment, a claim for services rendered or supplies furnished during the month of t).Erthe,Z , aot 5 , said claim being the sum of 1411kiollars ($ It51 ) in payment of which the Superintendent of Schools caused his/her Warrant Number tbco qq51 11 to be issued on t:Kgrrilsrc aci , drawn on the 030 Fund of Avondale Elementary School District of Maricopa County, Arizona. Claimant further says that although he/she was informed and believed that the above- mentioned warrant was regularly issued, the same has never been received or has been lost. Under penalty of perjury, claimant hereby affirms that this claim is correct and the amount shown is due and owing. Wherefore, claimant requests that the Board of Supervisors order and in the Superintendent of Schools issue him/her a duplicate of Warrant Number (00011 051 in the sum of $ 1035:13- . Claimant Signature Subscribed and sworn befgie me this 20_ 7 day a My commission expires: Notary Public) Seal: ••••''•' — '• — '• — •• —• •---•—•-------------. OFFICIAL SEAL i LAURA VERA i Notary Public - State of Arizona i MARICOPA COUNTY ' ; % . —..—..-------........—..-------- 'e‹.-Tifi:11-7 My Comm. Expires Aug. 31, 2017 ! Following approval please return this affidavit to Maricopa County Education Service Agency APPROVED JA 2 1 2016 AFFIDAVIT STATE OF-AREERtk k4NAdA OF SUPERVISORS )PA COUNTY COUNTY OFIZIETICOIVA0-- -) /if effery Z (_54A/e/,/being first duly sworn, upon oath deposes and says: That on the alflav of 340-.1"401-/55he presented to /f;aek-attle District of Maricopa County, Arizona, for payment, a claim for services rendered or supplies furnished during the month of 5erie416er 21 20 /.5—, said claim being in the sum of Oirt 74,91isaiyei7cap /444146-0-0( geYalf 7 Dollars, ($ I, Zy9 in payment of which the //eTa Superintendent of Schools caused his/her Warrant Number /9 002-49 2-k to be issued on 6e/efitZer- .21/, 20 /57-drawn on the 012- Fund of e Ver.5de 5eZab ( 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 /leo° Zo 9 Zi in the sum of $ f. /579. 7.7 JENNIFER HERNANDEZ NOTARY PUBLIC STATE OF NEVADA Signed: My Commission Expires: 05-19-19 Certificate No: 15-2066-1 Subscribed and sworn to before me this ay of 20 NOTARY PUB My commission expires: Following approval please retum this affidavit to the Maricopa County St 4 -Superintendents Office. Schools Affidavit/Claim Form . HD OF SUPERVISORS Application for a Duplicate Warrant/Check 4i1aZ 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. NAYDA R_. LATTREAro (1), being first sworn, upon oath deposes and says: Nameiciaimant On or about NOVEMBER 6 20 1 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 warra nt/Ah k be iss ed to /her in the sum of $ 9 6 5 7 3 .(3) Signed: (4) (5) Subscribed and SVor'n to before me this 1 4 day of _clEaraer 201 5 . 15185460 N&FARY PUBLIC 6/' OffI3'311 My commission expires: INDEFINITE Note: Please attach a copy of the warrant/check if available an evidence that a warrant/check was originally issued. Warrant/Check Number (if known) (6) 1 6 0 0 3 4 0 7 9 Original Date of Issue /1 - 0 —ZO/.5-- (if known) (7) Reason for original issue of Warrant/Check (8): IS( Payroll 0 For Services or Goods furnished Other: 301 PAYMENT 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 DAT JA 21 2016 STATE OF ARIZONA ERK BOARD OF SUPERVISORS COUNTY OF MARICOPA MARIGOPA COUNTY /9 /r e4, 12",„e_e 1 being first duly sworn, upon oath deposes and says: That on the )/-/-,siav of /t)z.) 20/5",—he presented to District of Maricopa County, Arizona, for payment, a claim for services rendered or supplies furnished during the month of AA,/ 20";; said claim being in the sum of 6)efLe,./%.,/r,‘j ($,)4.19 33 ) in payment of which the Superintendent of Schools caused his/her Warrant Number 5//, p V/ <2 to be issued on A)b , 20 ) 45"--drawn on the?3 0 Fund of E-a7- 7-- 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 /?9e/ /73./ in the sum of $ /S19. c--3. Signed: Ittruci TAREv9prAkEbeto roe this day of NOTARY PUBLIC, ARIZONA MARICOPA COUNTY My Commission Expires February 28, 2018 NOTARY PUBLIC My commission expires: Following approval please return this affidavit to the Maricopa County School Superintendents Office. AZTEC SPECIALTY PRODUCE CO Fresh Herbs, Fruits & Vegetables Since 1986 January 11,2016 East Valley Institute of Technology Faye Claridge PO #1400230 1601 West Main Street Mesa, AZ 85201 Dear Madam: Please except this letter as an apology for accidentally shredding your check number #401633180, dated 11-6-2015, in the amount of $149.53. Please reissue a check to replace the shredded check in the amount $149.53. If you have any further questions, please call me at 602-438-6855. Thank you for your business, /La Gary Fraizer Owner, Aztec Specialty Produce P.O. Box 15256 • Phoenix, Arizona 85060 • OFFICE 602.438.6855 • FAX 602.438.6878