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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 SUBJECT: Affidavits — Replacement of Lost Warrants DATE: 12/3/2015 Please find attached .ii?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 Schools Finance Division at 4041 N. Central Avenue #1200. #44 Avondale Breanne English $1235.40 #44 Avondale Luann Wing $117.62 #45 Fowler Mia Limones $64.36 #79 Litchfield Monica Martinez $14.66 #59 Laveen Estelle Perschbacher $910 #95 Queen Creek VWR International $473.62 RECEIVED DEC 0 4 2015 MARICOPA COUI\frt CLERK BOARD OF SUPERVISO //D vvY1,26t-Z AFFIDAVIT I APPROVFn STATE OF ARIZONA DEN 7 2015 COUNTY OF MARICOPA "lef OF- SLJPE-; MARICOPA COUNTY t5Ke-aNIN1-:-., CT-Ink being duly sworn, upon oath deposes and says: That on the day of N oklembek , 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 NCAlernbtfiC , abl , said claim being the sum of IWO .1-W-nOlkkrrairMortl i-14)1(gillars ($3 LID) in payment of which the Superintendent of Schools caused his/her Warrant Number ((i) ap Z11-1 Li1 to be issued on sKI) VeAltIQA-, \ (-14-13 , a0(5 , drawn on the OW 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 re quests that the Board of Supervisors order and in the Superintendent of Schools issue him/her a duplicate of Warrant Number UM:OZ .-17 Li in the sum of $ 13.35i go Claimant Signature Subscribed and swo bre N me this day of !.}ecem \a 201 5 My commission expires: ,1 36, 101 7 0 Not Seal: Notary RAQUEL Pudic- State ARAUjO o Atizona MARICOPA COUNTY MY Commission April 30, 2019 Expires Following approval please return this affidavit to Maricopa County Education Service Agency AFFIDAVIT APPP, STATE OF ARIZONA DEN 7 2015 COUNTY OF MARICOPA (5,141 .40 - MAHICOPA COUNTY LUO,NN NC being duly sworn, upon oath deposes and says: That on the (Ck day of MO VEATIb6K- , fl r ,) h/ e, s...e presented to the Avondale Elementary School District of Maricopa County, for payment, a claim for services rendered or supplies furnished during the month of NokiGmb-:-Z acl 5 said claim being the sum of cl \IQ. Jr-A/PCS/WI- ($ ) in payment of which the Superintendent of Schools caused his/her Warrant Number VeCO3 -1 -1-1(o to be issued on NGVerric0C. , 30(5 , drawn on the 0?)0 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 Roco?) .1 -11 Lo in the sum of $ till (47 Claimant Signatur Subscrib9d and sworn Vfore me this day of My commission expires: Notary Public) Seal: OFFICIAL SEAL I eN 1r, Notary LAURA Public - State VERA of Arizona MARICOPA COUNTY 7., My Comm . Expires Aug. 31, 2017 ! Following approval please return this affidavit to Maricopa County Education Service Agency 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. M t rnone 5 (1), being first sworn, upon oath deposes and says: Name/C anent On or about II/s17 iv t5 (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 $ f , 3 (p .(3) Signed: (4) ()-Subscribed a before me this rz(-- day of ,qc ,) 20 ( frE,t lizut NOTARY PUBLIC OFFICIAL SEAL BARBARA M. GILL My commission expires: Notary Public - Arizona / ,2t ci MARICOPAppANTY My CommissiblrEApires I I • t 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) Wc`t r'wli * I (403 kzLi c_Act k* Li5a 11 Original Date of Issue (if known) (7) 11 /71 /Z015 LV E D Reason for original issue of Warrant/Check (8): Payroll DATE DEC 07 2015 El For Services or Goods furnished LI 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 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. Monica Martinez (1), being first sworn, upon oath deposes and says: Name/Claimant On or about (clate)(2) a warrant/check was issued to the above named persoh/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 $ 14.66 .(3) Signed: '1)72A7)16 qTtekAy -Thli (4) (5) Subscribed and sworn to before me this JC day of AL/QM ber 20 / . (A*— NOTARY' BRITTANY CARTER Notary Public My commission expires: Maricopa County, AZ np-i/ c9,c/, 1-2(,)/ ci My Commission Expires (seal) April 29, 2019 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 16-0008656 (if known) (6) Original Date of Issue 08/13/2015 (if known) (7) Reason for original issue of Warrant/Check (8): 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