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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: 11/13/2015 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 Schools Finance Division at 4041 N. Central Avenue #1200. #5 Isaac SNAAZ $5627.75 #24 Gila Bend Melissa Mendoza $1320.13 #24 Gila Bend Tracey Arnold $843.47 RECEIVED NOV 1 6 2015 MAR1COPA COUNTY CLERK BOARD OF SUPERVISORS 10 flicol ob, APPROVED Affidavit NOV117 205 STATE OF ARIZONA RK., EOARD SUP7P. \71SOR:', MARICOPA COUNTY COUNTY OF MARICOPA ) SNAAZ (SCHOOL NUTIRITION ASSOC.), being first duly sworn, upon oath deposes and says: That on the 14TH day of SEPTEMBER, 2015 they presented to the ISAAC SCHOOL DISTRICT NO. 5 of Maricopa County, for payment, a claim for services rendered or supplies furnished during the month of SEPTEMBER, said claim being in the sum of FIVE THOUSAND SIX HUNDRED AND SWENTY SEVEN DOLLARS AND SEVENTY FIVE CENTS ($5,627.75) in payment of which the Superintendent of Schools caused his Warrant No. 460023649 to be issued on SEPTEMBER 14, 2015, drawn on the 510 fund of ISAAC SCHOOL DISTRICT NO. 5 of Maricopa County, Arizona. Affiant further says that although they were informed and believe 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 them a duplicate of said warrant number 460023649 in the sum of $5,627.75. Yury Christina Lopez Galvez icØ Notary Public — Maricopa County, Arizona (AUTHORIZED SIGNATURE/TITLE) My Comm. Expires 06-24-18 IriHh me this NI day o , 2015 (Notary Public) My commission expires 0)(-1I 1 Si Following approval please return this affidavit to Maricopa County Schools. SCHOOL NUTRITION ASSOCIATION -4 A October 30, 2015 State Officers 2015-2016 President Debbie Gasiorek, SNS Washington Elementary School Ms. Valtierra: District debbie.gasiorekPwesdschools.om This letter serves to authorize Cathy Wylet, SNAAZ Executive Secretary, as an 602.896.5233 eligible signer of the School Nutrition Association of Arizona for the President Elect requested Affidavit/Claim Form by the Isaac School District. Patti Bilbrey Scottsdale Unified c:School District pliilbrev@susd.org Sincerely, 480.484.6208 Vice President Crystal Gray Roosevelt School District crystal.gray@rsd.k12,az.us 602.243.2619 Secretary JOanie Burnap 'Queen Creek Unified School District iburnapPocusd.org 480.687.5970 Treasurer • -Erin Bronner, RD., SNS Layeen School District e bran nerP layeeneld.org 602.237.9100 X3044 Past President Shannon Gleave. R.D, SNS Glendale Elementary School District -.11-v,.- ',igleakieggesd40.org . 623.237.6244 AFFIDAVIT STATE OF ARIZONA COUNTY OF MARICOPA fi /4/7C)0 27_6 , being first duly sworn, upon oath deposes and says: That on the c2Ci day of / - 20 /S, he presented to 6"la p,ecLJicd District of Maricopa County, Arizona, for payment, a claim for services rendered or supplies furnished during the month of 20/5, said claim being in the sum of QIYA)_kAftxoA_VaGknWtlrKHAXA giga7s, ($)W. I /3 ) in payment of which the Superintendent of Schools caused his/her Warrant Number //‘'0.)2.8 57(0 to be issued on /6/') (7 , 20) ->- , drawn on the (0 Fund of rm; lo 6nd tini-red -s-kod 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 /66O2(f676; in the sum& $ //32/). /5 . ) SignedaVijad ....a,4,514Liagglasiajaitiwilaile before me this (( -l-A day of _,20 MARGARET PERRY Notary Public - Arizona Maricopa County My Comm. Expires Nov 9. 2018 NOTARY PU r ,20/8 Following approval please return this affidavit to the Maricopa County School Superintendents Office. pRi-k AFFIDAVIT V E D STATE OF ARIZONA _ 80,413D OF SU: COUNTY OF MARICOPA YARICOPA COUi•, f1rnacl , being first duly sworn, upon oath deposes and says: That on the 4;29 day of IC 201 5 , he presented to 6110 6_11d bal•-figi hob District of Maricopa County, Arizona, for payment, a claim for services rendered or supplies furnished during the month of /O/9S - 20/c, said claim being in the sum of 1r 11111-LA rnri) ,s miff Dollars, ($6 5-_ Uri) in payment of which the Superintendent of chools caused his/her Warrant Number /600Z 8 678 to be issued on /6/ c)q , 205 , drawn on the a-/ Fund of 6,10 betrittad-C-461 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 /1d62<L67g in the sum of $ Signed: u scn ed andvswro to before me this day of MARGARET Ftliti Notary Public - Arizona Marlcopa County My Comm. Expires Nov 9, 2018 My commission expires: le() 7; ,RO/8, Following approval please return this affidavit to the Maricopa County School Superintendents Office. MARICOPA COUNTY COA n Department of Finance 301 West Jefferson, Ste 960 20,15 7 Phoenix, Arizona 85003 ! kyX cd ,cc INTEROFFICE MEMORANDUM Date: November 17, 2015 To: Clerk of the Board From: Joyce Maurmann Department of Finance Subject: Affidavits — Replacement of Lost Warrants Please find attached 1 Affidavit for lost warrant to be included on the next available Board Agenda. • The attached item have been researched to ensure the warrant in question have not been cashed or previously re-issued. • The original warrant has a void/stale date/stop payment done. Please call me at 506-1343 if you have any questions. Please return the approved Affidavits to my attention in the Department of Finance, Suite 960. Thank you. Re: George M Delong PH D Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: Duplicate or Stale-Dated (definitions are on page 2) STATE OF ARIZONA Note: Numbers on this form correspond to COUNTY OF MARICOPA numbers on the Instruction sheet ' , %hich is pace 2 of this form. George M Delong PHD (1), being first sworn, upon oath deposes and says: Name Claimant On or about 08-Oct-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 issued to him/her in the sum of $ 1,755.00 .(3) Signed: 44. A, a (4) Note: Please attach a copy of the wan -ant/check if available and/or any other evidence that a wan-ant/check was originally issued. (5) Subscribed and sworn to before me this A day of Not)enkkNer 20 NOTARY PUBLIC BARBARA ANDERSON Notary PublIC - State Adzona My commission expires: My NAVAJO C,ommission COMM' Expires NOv . 4-110 November 4, 20 Warrant/Check Number 360008520 (if krown) (6) Original Date of Issue 08-Oct-2015 (if krown) (7) Reason for original issue of Warrant/Check (8): E Payroll / For Services or Goods furnished E Treasurer's refund/payment E Other: