Extracted text (via tesseract_tsv)
16119 characters
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: 10/8/2015
Please find attached 7 Affidavit/Notice of Claim(s) for lost warrants for inclusion on the
next available Board agenda
Vv 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.
#68 Alhambra Angel Ruiz $362.04
#59 ~—Laveen Holly Rivers $218.52
#214 Tolleson Mario Lamont Jimerson $415.57
#95 Queen Creek Shanita Powell $133.96
#31 ~~ Balsz Skyline Builders $20107.21
RECEIVED
OCT 68 2015
MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS
lo mact ala
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.
ANGEL RUIZ (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about _ /O-S -/5 (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 ¢ 362. 04 (3)
|
Lou WD 7m
Signed: (4)
(5)
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5 1 33 1 1 2 555 2028 143 40 95.713219 Please
5 1 33 1 1 3 725 2028 136 40 96.519928 attach
5 1 33 1 1 4 888 2037 27 30 95.221153 a
5 1 33 1 1 5 944 2037 105 39 95.221153 copy
5 1 33 1 1 6 1073 2027 52 40 96.577797 of
5 1 33 1 1 7 1145 2027 70 39 93.170197 the
5 1 33 1 1 8 1246 2025 314 48 92.749214 warrant/check
5 1 33 1 1 9 1583 2025 39 39 96.008881 if
5 1 33 1 1 10 1639 2024 192 41 96.394920 available
5 1 33 1 1 11 1858 2023 151 47 94.386963 and/or
5 1 33 1 1 12 2032 2032 84 39 96.486870 any
5 1 33 1 1 13 2141 2022 121 40 96.930084 other
4 1 33 1 2 0 390 2085 1141 50 -1
5 1 33 1 2 1 390 2088 195 40 96.328224 evidence
5 1 33 1 2 2 602 2088 90 39 95.891182 that
5 1 33 1 2 3 702 2098 27 29 93.250832 a
5 1 33 1 2 4 748 2087 312 47 91.599098 warrant/check
5 1 33 1 2 5 1075 2096 84 30 96.477020 was
5 1 33 1 2 6 1173 2086 201 49 95.065376 originally
5 1 33 1 2 7 1384 2085 147 40 85.385017 issued.
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3 1 35 1 0 0 311 2207 998 93 -1
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5 1 35 1 1 1 311 2207 331 47 92.142838 Warrant/Check
5 1 35 1 1 2 660 2207 172 39 96.543282 Number
4 1 35 1 2 0 486 2224 823 76 -1
5 1 35 1 2 1 486 2264 168 36 31.185612 Check
5 1 35 1 2 2 669 2264 45 36 55.799194 Mu
5 1 35 1 2 3 930 2224 379 52 92.121788 1-6-0023114
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3 1 36 1 0 0 286 2290 2008 14 -1
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5 1 39 1 1 4 677 2315 114 38 96.547813 Issue
4 1 39 1 2 0 486 2331 672 77 -1
5 1 39 1 2 1 486 2372 36 36 95.132484 (if
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5 1 39 1 2 3 669 2371 46 37 96.974747 (7)
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3 1 42 1 0 0 314 2466 1032 117 -1
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5 1 42 1 1 3 566 2472 157 50 96.126450 original
5 1 42 1 1 4 744 2473 106 39 96.901703 issue
5 1 42 1 1 5 869 2471 43 41 96.946991 of
5 1 42 1 1 6 926 2466 325 101 89.125542 Warrant/Check
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4 1 42 1 2 0 390 2533 216 50 -1
5 1 42 1 2 1 390 2536 36 37 0.000000 jl
5 1 42 1 2 2 464 2533 142 50 88.177666 Payroll
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5 1 44 1 1 3 550 2625 179 39 96.740799 Services
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5 1 44 1 1 5 807 2623 134 40 96.632973 Goods
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5 1 47 1 1 1 312 2960 365 34 88.939438 S:\PROCESSES\Warrants
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5 1 47 1 1 5 897 2959 118 32 83.543907 Stale\02
5 1 47 1 1 6 1029 2957 477 34 92.149231 Forms\Schools\Schools-Warrants
5 1 47 1 1 7 1518 2957 102 27 96.903221 Checks
5 1 47 1 1 8 1632 2957 86 26 96.904976 notice
5 1 47 1 1 9 1729 2956 31 27 93.281189 of
5 1 47 1 1 10 1769 2955 136 28 93.126381 claim.doc
4 1 47 1 2 0 313 2995 1903 33 -1
5 1 47 1 2 1 313 3001 109 27 96.107613 Revised
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5 1 47 1 2 3 516 3001 70 26 96.427238 2015
5 1 47 1 2 4 1866 2996 87 26 42.367714 A.R.S.
5 1 47 1 2 5 1969 2995 99 27 92.931221 11-632
5 1 47 1 2 6 2080 2995 23 26 92.931221 &
5 1 47 1 2 7 2115 2995 101 26 96.930695 15-999
Application for a Duplicate or Stale-Dated Warrant/ Check
Affidavit/ Claim Form
This application is for: Duplicate or LJ stale-Dated (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.
Holly Rivers (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about September 24,2015 — (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 after the date of issuance.
year
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 $ 218.52 (3)
. lly
Signed: il AAMAS (4)
Note, Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
(5) and sworn to me this nf day of Qc deber 2015
subscribed BEI
B/ corm Chor a
2
ROTARY PUBLIC
z NAOMI ORONA :
ms ML Maricopa. County
a f2Ve 0// My Comm. Expires Apr'27, 2016 (seal)
Warrant/Check Number | 469921284
(if known) (6)
Original Date of Issue
9/24/20105
(if known) (7)
Reason for original issue of Warrant/Check (8):
Payroll
O For Services or Goods furnished
(11 Treasurer's refund/payment
[1 Other:
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc
Revised April 2015 A.R.S. 11-632 & 11-644
AFFIDAVIT
STATE OF ARIZONA
COUNTY OF MARICOPA
Mario Lament Simson, being first duly sworn, upon oath deposes and
says:
That on the 4 day of dep} 20/5 he presented to Télleson Unwn School
, Hish Dist
Fe
District of Maricopa County, Arizona, for payment, a claim for services rendered
or supplies furnished during the
month of Sept. I$ 20/S°, said claim being in the of
sum
Four Handed Ffiren * Dollars, ($US. S71) in of which
payment the
Superintendent of Schools caused his/her Warrant Number / 60014 63 | to be
issued on Sept. [9 » 20)‘, drawn on the Go| Fund of Tolleson Uniea Schael
Tigh Orgs
Py
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
ogi 57,
21.
ye
EA
7
Subscribed sworn to before me this 4 day of O cele 2015
NOTARY PUBLIC
My commission expires: Dec ery be FoR
23,
Following approval please return this affidavit to the Maricopa County School Superintendents Office.
Ti, TERESA DUKES BLAND
Notary Public - State of Arizona
<jJ§} MARICOPACOUNTY
My Commission
December 23, 2018 Expires
ELE WE Th mR Oe ena match Aa eee
as tee
~aemy”
. s ‘
Schools Affidavit/Claim Form ( Bag i
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.
Shanita Powell (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about _ /0 /d//20/5° (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
133.96
warrant/check be issued to him/her in the sum of $ (3)
Signed: Bhan T (4)
(5) Subscribed and sworn to before me this lpth day of Oecr ‘ 20 \D .
NOTARY PUBLIC
E%, LORI ANN PLATTS
FN) Notary Publio- Stato of Arizona
My n expires: heey fa seecial ero
com i“ Q \F l May 2, 2019 (sebl)
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 | 4_6.9023355
(if known) (6)
Original Se Date of Issue
10/1/2015
aocenl ie
Reason for original issue of Warrant/Check (8):
Payroll
1 For Services or Goods furnished
C1 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
aA
AFFIDAVIT
|
-
STATE OF ARIZONA
COUNTY OF MARICOPA
kyu NE Ku (40 €2 S _, being first duly sworn, upon oath deposes and says:
(Name and Title of Person)
That on Jury 30,20 /5_, he/she presented to SALSZ SCHOOL. ay ST.#4#-3! _ of
(School District Name)
Maricopa County, Arizona, for payment, a claim for services rendered or supplies furnished during the
month of ol Ute 20_| 5, said claim being in the sum of ($ 40,) 07. Al)
wemry ‘Tiebtibdeisis Owe Huw 04 80 Sev én and s* Dollars in payment of which
the enpernicaelent of Schools caused his/her Warrant Number _“44@00 /O.52.0 _ to be issued
on A uc. (& _,20/5_,drawnonthe O00 Fund of Barsz PCHOOL Dist-H#31 of
(School District Name)
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 “60 /O5A2O_inthe sumof$ AO, /07. Al.
WWiAeee...s
Signed:
(Name shamed Personnel) SAU Oo. CoHlce ;Ce& ° D
Subscribed and swornto os before me this_ 2S day of Septembe 201s
laa iH Talal ( Vit {ye etn Ana,
NOTARY PUBLIC: (Si |
ricopa County
commission S ANG [U4 AO] Cw CONE 14 2017
My expires:
Following approval please return this affidavit to the Maricopa County Education Service Agency Office.
Certificate of Corporate Authority
I, Michael N. Lee , certify that | am the President of
Skyline Builders & Restoration, Inc. , that Sally J. Cohill who
signed the Affidavit on behalf of Skyline Builders & Restoration, Inc. , was then the
Chief Executive Officer of Skyline Builders & Restoration, Inc. :
that said Affidavit was duly signed for and in behalf of Skyline Builders & Restoration, Inc.
by authority of its governing body, and is within the scope of its corporate powers.
L2
LY ae 10/07/15
N. Lee, President — Date
/ wipe
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