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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: 10/5/2015 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 fo 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, #45 Fowler Loretta Garcia $251.65 #79 — Litchfield Massey’s Diesel Repair $517.20 RECEIVED OCT 06 2015 MARICOPA COUNTY CLERK BOARD OF SUPERVISORS (lo mal aly 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 Lo ret AN Garcia (1), being first sworn, upon oath deposes and says: ~ Name/Claimant On or about qf 25 L: ZOLS” (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 warrafit/check te jssued to him/her in the sum of $ $ 251.65 (3) Signed: : DA Ot (4) : X — = ; OFFICIAL SEAL NOTA PUBLIC | JOANN BORUNDA Notary Public - Arizona ~wwwwwwwe MARICOPA COUNTY My gommission expires¢). 3 Y Ny Commission Expires APRIL ey 4 je (seal) 18,2017... Uh Note: Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. warrant © /C heck ¥ Warrantjcheck Number [fo sh [L002/220 7 45210172. J Original Date of Issue a / /} S (if known) (7) Zs Reason for original issue of Warrant/Check (8): DK Payroll O 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 LITCHFIELD ELEMENTARY SCHOOL DISTRICT Wl) 272 East Sagebrush Street » Litchfield Park, Arizona 85340 » 623.535.6000 » Fax 623.935.1448 » www.lesd.k12.az.us ‘A Stronger Mind for a Stronger Future” AFFIDAVIT | STATE OF ARIZONA } } Ss. COUNTY OF MARICOPA } A representative of Massey’s Diesel Repair, Inc. being first duly sworn, upon oath deposes and says: That on the 7thof — July, 2015 she <he> presented to the Litchfield Elementary School District # 79 of Maricopa County, for payment, a claim for services rendered or supplies furnished during the month of July, 2015, said claim being in the sum of FIVE HUNDRED SEVENTEEN AND 00/20 Dollars ($517.20) in payment of which the Superintendent of Schools caused Warrant No. 460004955 to be issued on 07/16/2015, drawn on the MAINTENANCE AND OPERATION Fund of Litchfield Elementary School District # 79 of Maricopa County, Arizona. Affidavit further states that although you were informed and believes that the above mentioned warrant was regularly issued, the same has never been received or has been lost, stolen or destroyed and has never been deposited. WHEREFORE, affiant prays that the Board of Supervisors order and the Superintendent of Schools issue to MASSEY’S DIESEL REPAIR, INC, a duplicate of said Warrant No. 460004955 1 of $517.20. ene" AA 1 , Sept 4 OS Subscribed and sworn to before me this & day of ( } a” U SINDRA & RAMIREZ (nano x KEE «) Notary Publi¢—Arizona : ny Notary Public WS) Maricopa County ~ Expires 06/30/2016 | commission expires: (J Une ao a0 | My . Following approval, please return this affidavit to Maricopa County Superintendent’s office. sse,,, gern" MASSEY’S DIESEL REPAIR, INC. P O Box 14029 Phoenix, AZ 85063-4029 Ph. 602.233.1700 * Fax 602-269-2850 9/25/15 Litchfield Elementary School District 272 E. Sagebrush Street Litchfield Park, AZ 85340 ATTN: MARTH IRIBE I, Michelle Lynch the Office Manager at Massey’s Diesel Repair, Inc. Am an authorized signer for Massey’s Diesel Repair, Inc. as shown on the Affidavit I mailed back. Please expedite the check to us as soon as possible as your account is approaching 90 days past due. Sincerely, Michellé Lynch Office Manager Massey’s Diesel Repair, Inc.