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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: 11/5/2015 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. #1 Phoenix El. AZ Spray Equipment $73.92 #7 Wilson Pearson Assessments $2313.09 Irk: RECEIVED NOV 06 2015 MARICOPA COUNTY CLERK BOARD OF SUPERVISORS icA AFFIDAVIT APPROVED M062 STATE OF ARIZONA K _ _ RDOFSUPEHVISORS MARICOPA COUNTY COUNTY OF MARICOPA AZ Spray Equipment being first duly sworn, upon oath deposes and says: That on the 30th, January 2015_presented to PHOENIX ELEMENTARY SCHOOL DISTRICT #1 of Maricopa County, for payment, a claim for services rendered or supplies furnished during the month of January 2015 said claim being in the sum of $73.92 in payment of which Superintendent of Schools caused his/her Warrant No. 46-0003215 to be issued on, drawn on the 001 Fund of PHOENIX ELEMENTARY SCHOOL DISTRICT #1 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 No. 46- 0003215 I the sum of $73.92. MiscaiziQ. fi ff Militiayoh.62 1/2/15 Signature CA- Subscribed and sworn before me this .. day of ,20.15 CARI M RITTER Notary Public,State of Arizona Maricopa County Notary Public My Commission Expires "ruary 19, 2018 Following approval please return this affidavit to COUNTY SCHOOLS OFFICE 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. (1), being first sworn, upon oath deposes and says: Name/Claimant On or about I() 0 .51 0 (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 $ (-9.30, 09 .(3 ) Signed: 0'74 (4) (5) Subscribed7andworn to before me this ,2 g day of IV6--627,e4' 20 Jr. x Huma John NOTARY PUBEY Notary Public New Jersey My Commission Expires 5-5-2016 My commission expires: Comm. No. 2408207 oc-/Dci2 16 (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 c , - 0 (if known) (6) 11.71- ,__.- 0 0 / C(,/3 / Original Date of Issue r e-- (if known) (7) 6 / ii itc400/ Reason for original issue of Warrant/Check (8): D Payroll 1/4_7 0 For Services or Goods furnished 0 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 PEARSON 200 Old Tappan Road Old Tappan NJ 07675 October 14, 2015 Wilson Elementary School 3025 E. Fillmore Street Phoenix, AZ 85008 ATTN: Accounts Payable Lupe Orosco RE: Lost Check/Not Received/Cashed This letter is written to notify you that our company has not received, nor cashed, check #450098659, issued 6/11/2015, in the total amount of: $2,313.09 which was to pay for invoice #.10229321 which was due 18-JUN-2015. This check was sent to an address that is not the correct lockbox address which explains why the check was not received, cashed, or forwarded to the correct address. The check is considered, "LOST" at this point and should be canceled by your bank and a new payment reissued and mailed to the correct lockbox address. ALL payments should be mailed to the address located in the bottom right corner of our invoices which is 13036 Collection Center Drive, Chicago, IL 60693. Please contact me for additional questions you may have regarding this issue. Thank you. Jenny Sanderson Pearson/NCS Pearson, Inc. Credit and Collections Department (P) 800-843-0019 EXT #755 (F) 480-457-7610 (F) 201-767-5029 Jenny.sanderson@pearson.com To request a fax copy of an invoice or credit memo visit us at www.oasis.Dearsoned.com