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INTEROFFICE MEMORANDUM Maricopa County Education Service Agency TO: Crerkof tfie Ooarci FROM: ECsa Perez SUBJECT: Affidavits — Repfacement of Lost /Stc& Warrants DATE: 12/2/2015 Pase find attached Affidavit/Notice of Cfaim(s)for lost warrants for inclusion on the next avada6re Ooard agenda. The attached item(s) have been researched to ensure that the warrant(s) in question have not 6een cashed or previously re-issued. The original- warrant (s) have had a stop payment done. If you have any questions, please contact Eksa Perez at (602) 506-3533 or via e-mail at garnishments@mcesa.maricopa.gov . Approved Affidavits may 6e routed 6ack to the Ilaricopa County Education Service Agency at 4041 1I1: Central- Avenue #1200, ( 12tfi Efoor) Thankyou. 'Fund: 781 10.7-1W-D(398-WE $1049.23 RECEIVED DEC 0 4 2015 MAR;COPA (;OLINITY CLERK BOARD OF SUPERVISORS //8 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: • Duplicate or 0 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. JOHN DONOHUE (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 26TH OF NOVEMBER 2015 (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 • ued tç him/her the sum of $ 1049.23 .(3) (gitnic(11. (4) Note: Pl&Se attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. (5) Sui4cribed pdAvvorn to before me this 2.."1 day of (1 2_id3Pi 20 IS . NOTARY PUBLI RIVAI1J Notary MARICOPA Public - COUNTY My Commission Expires April 8, 2019 My commission -expires: (seal) Warrant/Check Number 160041876 (if known) (6) Original Date of Issue 26TH OF NOVEMBER 2015 (if known) (7) Reason for original issue of Warrant/Check (8): I* Payroll LI For Services or Goods furnished O Treasurer's refund/payment O Other: S:\PROCESSES\Warrants - Duplicate or Stale \02 Forms \Warrants Checks notice of claim - Copy.doc Revised April 2015 A.R.S. 11-632 & 11-644