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INTEROFFICE MEMORANDUM Maricopa County School. Superintendent 5 Office TO: CLERK OF THE BOARD FROM: Millie Thompson SUBJECT: Affidavits DATE: 11/30/2015 Please find attached __3 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 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. # 60 HIGLEY AMANADA KAYE $227.50 #60 HIGLEY LANCIO PARTNERS $3200.00 #68 ALHAMBRA GERARDO CHAVARRIA $841.39 DEC @ 4 2015 MARICOPA COUNTY CLERK BOARD OF SUPERVISORS os 4 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. Gerardo Chavarria (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 11/12/15 (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 $ 841.39 (3) Signed: (Rene de Choa! o (4) (5) me this 20, Z hy day of No venbe, 2015. pres PTT NOTARY PUBL My W127 ji apes (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 160034597 (if known) (6) Original Date of Issue 11/12/2015 (if known) (7) Reason for original issue of Warrant/Check (8): ml Payroll LC] For Services or Goods furnished () 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 Instruction sheet which is page 2 of this form. COUNTY OF MARICOPA Amanada Kaye (1), being first sworn, upon oath deposes and says: ~~ Name/Claimant On about Wa2 a= (date)(2) a warrant/check was issued to the or 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 ¢ 227.50 (3) Ay Qi p bax (4) Signed: and sworn to before me this __7 day of Wrvew be 2018 . w/a NOTARY PUBLIC CS ‘pe OFFICIAL SEAL . LEAH CRUZ My commission expires: Dlo- 14 : TROPA COUNTY. (seal) [Os H 26,2019 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 4600263370 (if known) (6) Original Date of Issue | 99/99/2015 (if known) (7) Reason for original issue of Warrant/Check (8): O Payroll refund O For Services or Goods furnished lm Other: refund S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc A.R.S. 11-632 & 15-999 Revised June 2015 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. Lancio Partners LLC (1), being first sworn, upon oath deposes and says: Name/Claimant On or about (©//5/ 2c1s~ (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 ae in the sum of $ 3200.00 (3) eal io Signed: ‘ : (4) — (5) Subscribed and sworn to before me this 2? day of f) imemhor20 [d. NOTARY PUBLIC FRANCES T. RIVAS My commissjon expires: Notary Public—Arizona 1.3 Lf Zoll Maricopa County (seal) 7 Expires 01/31/2016 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 460033236 (if known) (6) Original ginal Date of of Is Issue 10/13/2015 Date EEE Reason for original issue of Warrant/Check (8): C1 Payroll | For Services or Goods furnished | 1 Other: §:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of daim.doc Revised June 2015 A.R.S. 11-632 & 15-999 ® AACLO LANCIO PARTNERS LLC 5326 N. 26th STREET - PHOENIX, AZ 65016 - tet 602.667.0436 » fax 602.667.0598 November 2, 2015 This is to verify | am the sole proprietor and owner of Lancio Partners LLC. Thank-you, Sara J. Bresahan Founder and Partner, Lancio Partners LLC