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I ttt v:1 t 1, 'V - Maricopa County Human Resources 2015 SEP 21 PM 2: 1 0 (Ve,\ I Vet ec( Merio To: Fran McCarroll, Clerk of the Board From: Debra Upton Date: September 21, 2015 Re: Replacement of Lost Payroll Warrants Please find attached 2 Affidavit/Notice of Claim(s) for lost payroll warrants for inclusion on the next available Board agenda. The attached item(s) have been researched to ensure that the warrant(s) in question have not been cashed or previously re- issued. The original warrant(s) have had a stop payment done. Please call Debra U. at ext. 66329 for any questions. Please route approved Affidavits back to County Payroll, Suite 220. Stale Dated Warrant DuplicatejWarrant Thank you. Replacement Lost Warrant Form 1 02125/2015 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: Duplicate or gl 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. Ginny-Lee Richardson (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 12/3/2014 (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 su .(3) Signed: Note: Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. (5) bscribed and sworn to beforAid e this q-74/1 day of fer)--)Lei- 20 r N iiII1111111111 SARAH MICHELLE SMITH My commission expires: NOTARY PUBLIC -ARIZONA 3.eptemai- - / Jo 1 Maricopa County (seal) My Commission Expires September 12 2018 Warrant/Check Number 22240412 (if known) (6) Original Date of Issue 12/3/2014 (if known) (7) Reason for original issue of Warrant/Check (8): N) 14 Payroll LI For Services or Goods furnished LI Treasurer's refund/payment LI Other: RK BOARD OF SUPERVISORS Revised April 2015 MARICOPA COUNTY A.R.S. 11-632 81. 11-644 EMP lutb 81105852„9 Stale Dated Check Claims 1. Please provide a statement validating that there is good and sufficient reason for not presenting the original warrant/check for payment before the voided date. 7 /on/0-/-11-1 r C'e ) (-r-7 tt7i 2. Where would you like us to mail the replacement warrant/check? Li 71"-- 3. If available, please attach the original warrant/check or a copy along with the notarized affidavit and this form to: Maricopa County Elections Dept. Attn: Payroll Division 111 S. 3rd Ave, Suite102 Phoenix, AZ 85003-2294 Please contact Deyan Bunjevic at 602-506-2471 or Lorraine Garrett at 602-506-2492 if you have any questions. 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: 9/21/2015 Please find attached 4 Affidavit/Notice of Claim(s) for lost warrants for inclusion on the next available Board agenda -,/ The attached item(s) have been researched to ensure that the warrant(s) in question have not been cashed or previously re-issued. -,/ The original warrant(s) have had a stop payment done. Please contact Denise Weihe at 506.7121 or via e-mail at denise.weihegmcesa.maricopa.gov if you have any questions. Approved Affidavits may be routed back to the Superintendent of School Finance Division at 4041 N. Central Avenue #1200, (12th Floor) Thank you. #60 Higley Phoenix Children's Hospital $4344.08 #60 Higley Phoenix Children's Hospital $4344.08 #60 Higley PADT $11809.21 #94 Paloma Human Relations Media $791.67 RECEIVED SEP 2 1 2015 CLERK MARICOPA BOARD OF COUNTY SUPERVISORS iip OACA AUG 2 4 2015 APPRoVED 4T AFFIDAVIT SEP) 1 2015 STATE OF ARIZONA COUNTY OF MARICOPA 134-07- , being first duly sworn, upon oath deposes and says: ccl That on the day of 20 /67he presented to District of Maricopa County, Arizona, for payment, a claim for services rendered or supplies furnished during the month of Yra-Li 20 said claim being in the sum of L A (-Qd 'et ad fllt n e- e kv4v' 411ou5andef (JO- nullbol tars, ($1 I Mi,-)1) in payment of which the Superintendent of Schools caused his/her Warrant Number 14 5 co ?ea q /f8 be issued on , 20i5 drawn on the LIDO Fund of 14i• L)t'fi ed 47)00 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 1-16:)609/411 /..) in the sum of $ 23.661-I Signed: efore me this day of NOTARY PUBLIC My commission expires: iij c-2 Following approval please return this affidavit to the Maricopa County School Superintendents Office. Phoenix Analysis & Design Technologies To whom it may concern, I, Eric Miller, hereby authorize Joshua Heaps to sign this affidavit on behalf of PADT inc. in regards to re- issuing payment for PADT invoice 44815. Eric Miller Principal PADT, Inc. ASU Research Park • 7755 S. Research Dr. • Suite 110 • Tempe, AZ 85284 1-800-293-PADT • (480) 813-4884 • FAX (480) 813-4807 www.padtinc.com AFFIDAVIT STATE OF ARIZONA COUNTY OF MARICOPA 14ccen,1i, . 01-v;i oecto _s , being first duly sworn, upon oath deposes and says: hosio rktiL. c)(2:roo PE PicS That on the day of Sep-t- 20 5, he presented to District of Maricopa County, Arizona, for payment, a claim for services rendered or supplies furnished during the month of Akio\ 20 15-, said claim being in the sum of i_v ti--) - re e /ixDollars, 4ff ($ 1t) in payment of which the i-k-tina red Superintendent of Schools caused his/her Warrant Number tp tv7)) Li 3 /A) to be issued on A-Qc), 1B , 206 , drawn on the 6a_5 Fund of k VS 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 Gob ?)LeC) in the sum of $ 4, 9-1Li De) DEBRA PIKE ) Notary Public - Arizona Maricopa County Signed: My Comm. Expires Jun 17, 2017 1 . 11"11"11PIWwW41101119. Subscribed and sworn to before me this ci day of 71- ,20 PL,La ( NOTARY PUBLIC My commission expires: ,IL,4r) / 7,,c770/ Following approval please return this affidavit to the Maricopa County School Superintendents Office. Center for Pediatric Orthopaedics September 17, 2015 Emily And risevic, MD Mohan V. Belthur, MD Higley Unified School District #60 Randon T. Hall, MD, MBA 2935 S Recker Road Kimberly M. Hornbeck, MD Gilbert AZ 85295 Judson W. Karlen, MD Attn: Lisa Bates Brian D. Kelly, MD To Whom It May Concern: Peter D. Masso, MD Jeffrey M. Vaughn, DO Please note that Amy Whitford is an authorized signer of the affidavit. Greg R. White, MD Sincerely, Kristina M. Wilson, MD Mandy Falk, PA-C Perry Edinger, PA-C Debby Pike Morgan Jones, PA-C Administrative Assistant II Our locations: Center for Pediatric Orthopaedics Phoenix Children's Hospital Phoenix Children's Hospital 1919 East Thomas Road Phoenix, AZ 85016 Phone: (602) 933-3033 Fax: (602) 933-5245 East Valley 5131 E. Southern Ave. Mesa, AZ 85206 Northwest Valley 20325 N. 51 st Ave. Glendale, AZ 85308 Southwest Valley 1665 N. Avondale Blvd Avondale, AZ 85392 Scottsdale 6990 E. Shea Blvd Scottsdale, AZ 85254 Specializing in the Surgical Care of Infants, Children, and Adolescents, including: Clubfeet Complex Spine deformities ODH Limb length discrepancies Neuromuscular disorders Pediatric fractures Scoliosis Sports Medicine Visit us at: www.phoenixchildrens.com APPlij AFFIDAVIT DATj SEP1 201 STATE OF ARIZONA BOAIR - IAARICOPA CUUNP( COUNTY OF MARICOPA N' -k- I t...0 s , being first duly sworn, upon oath deposes and says: Q rsPil-14L. cataTi4oPED I C That on the e) day of fieft 20 15 , he presented to . 11.)SLY- 06 District of Maricopa County, Arizona, for payment, a claim for services rendered or supplies furnished during the month of 7 I..) 2015 , said claim being in the sum of C)or /610USACJ-)01 ±t,/ lee. Dollars, (039`/L0) in payment of which the Yruy-lore anci For- 4-1 - r-bc) r 9 Superintendent of Schools caused his/her Warrant Number /0 0 6,01/ 58 to be issued on 3L.AIi A 5 , 20 15 , drawn on the 55 Fund of 1-1-0 SD idle& 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 1-UPDOO (05b9 in the sum of $ 93csi.68. -:711t Lti DEBRA PIKE Notary Public - Arizona 0 MAI r wit/.74 )01#11uni IIrurII Signed: L/A,b' Vd 1/11Couritrr »jr Subscribed and sworn to before me this 9 day of ,Jel" p ± ,20 /3 CciaL) NOTARY PUBLIC My commission expires: -7 UT) I 71_32_0/7 Following approval please return this affidavit to the Maricopa County School Superintendents Office. Center for Pediatric Orthopaedics September 17, 2015 Emily Andrisevic, MD Mohan V. Belthur, MD Higley Unified School District #60 Randon T. Hall, MD, MBA 2935 S Recker Road Kimberly M. Hornbeck, MD Gilbert AZ 85295 Judson W. Karlen, MD Attn: Lisa Bates Brian D. Kelly, MD To Whom It May Concern: Peter D. Masso, MD Jeffrey M. Vaughn, DO Please note that Amy Whitford is an authorized signer of the affidavit. Greg R. White, MD Sincerely, Krishna M. Wilson, MD Mandy Falk, PA-C Perry Edinger, PA-C Debby Pike Morgan Jones, PA-C Administrative Assistant II Our locations: Center for Pediatric Orthopaedics Phoenix Children's Hospital Phoenix Children's Hospital 1919 East Thomas Road Phoenix, AZ 85016 Phone: (602) 933-3033 Fax: (602) 933-5245 East Valley 5131 E. Southern Ave. Mesa, AZ 85206 Northwest Valley 20325 N. 51 st Ave. Glendale, AZ 85308 Southwest Valley 1665 N. Avondale Blvd Avondale, AZ 85392 Scottsdale 6990 E. Shea Blvd Scottsdale, AZ 85254 Specializing in the Surgical Care of Infants, Children, and Adolescents, including: Clubfeet Complex Spine deformities DDH Limb length discrepancies Neuromuscular disorders Pediatric fractures Scoliosis Sports Medicine Visit us at: www.phoenixchildrens.com Schools Affidavit/Claim Form K, PEPVISORIS -- MAHICoRA - COUNTY 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. Human Relations Media (1), being first sworn, upon oath deposes and says: Name/Claimant On or about June 18,2015 (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 $ 791 -67 .(3) Signed: (4) (5) Subscribed and sworn to before me this pf ST day of NOTARY PUB C MARY F DEGNAN Notary Public, State of NOW York Mv commission expires: Qualified No. In 02DE4948944 Westchester Coon_ 2-7 - Commission Expires March 27, 20./.; (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 450101106 (if known) (6) Original Date of Issue 06/18/2015 (if known) (7) Reason for original issue of Warrant/Check (8): 0 Payroll II 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 f HUMAN (914) 244-0486 RELATIONS Fax: (914) 244-0485 Toll-Free: (800) 431-2050 MEDIA 41 KENSICO DRIVE, MT. KISCO NY 10549 Web Site: www.hrmvideo.com August 21, 2015 School Expense Warrant Treasurer of Maricopa County Phoenix, AZ To Whom It May Concern: Elaine Napolitano is authorized to sign the Schools Affidavit/ Claim Form stating Check number 45010116 dated June 18, 2015 was lost by our bank. Sincerely, 11,2 Yair Kadmon President INTEROFFICE MEMORANDUM Waricopa County Education Service Agency TO: Crerkof the Ooard FROM: Susana Eraire/Ersa Perez SUBJECT: Affidavits — Wcpfacement of Lost /StaTh Warrants DATE: 9/17/2015 Pase find attached _1_ Affidavit/Notice of Claim(s)for Cost warrants for inclusion on the next available Ooard agenda. The attached item(s) have been researched to ensure that the warrant(s) in question have not been cashed or previously re-issued -\1 The originafwarrant(s) have had a stop payment done, If you have any questions, please contact Samna Eraire/Eaa Perez at (602) 372-8425 or (602) 506-3533 or via e-mail at garnishments@mcesa.maricopa.gov. Approved Affidavits may be routed back to the Maricopa County Education Service Agency at 4041 IV: CentrafAvenue #1200, ( 12th Efoor) Thankyou. Eund 781 ELIWIDA SAAVEDM $316.20 RECEIVED SEP 21 2015 MARIC;OPA COUNTY CLERK BOARD OF SUPERVISORS , /0 Velicaei Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: gi Duplicate or 0 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. ELINIDA SAAVEDRA (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 26TH OF AUGUST 2015 (date )(2) )(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 $316.20 .(3) Signed: -, 4:.).):(--t) d\-').dtitlAx-cLe_;I (4) Note: Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. (5) Subscribed and sworn to before me this IS‘--1 day of Sp p tooLo-a--, 20 /61 NOTARY PUBLIC PUBLIC My commission expires: LILA FAY STREAVEL 's Notary Palk; - State of Arizona LIWN n 1 ri.4ARICOPA COUNTY (seal) My Commission Expire* MeV 7. 2017 Warrant/Check Number 160012838 (if known) (6) Original Date of Issue 8/26/15 (if known) (7) Reason for original issue of Warrant/Check (8): El Payroll LI For Services or Goods furnished El Treasurer's refund/payment 111 Other: S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc Revised April 2015 A.R.S. 11-632 & 11-644 i Maricopa County 2015 SEP 2 1 PM 2: 1 0 Human Resources \ck C\,ei Memo To: Fran McCarroll, Clerk of the Board From: Debra Upton Date: September 21, 2015 Re: Replacement of Lost Payroll Warrants Please find attached 2 Affidavit/Notice of Claim(s) for lost payroll warrants for inclusion on the next available Board agenda. The attached item(s) have been researched to ensure that the warrant(s) in question have not been cashed or previously re- issued. The original warrant(s) have had a stop payment done. Please call Debra U. at ext. 66329 for any questions. Please route approved Affidavits back to County Payroll, Suite 220. Stale Dated Warrant Duplicate)Warrant Thank you. Replacement Lost Warrant Form 1 02/25/2015 A P 111 1L! SEP%2 4 2015 DAT - R7CIF SUPTRVISORS AFFIDAVIT/NOTICE OF CLAIM MARICOPA COUNTY STATE OF ARIZONA COUNTY OF MARICOPA MYRNA ELLEN AUMAN BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on the 26TH day of AUGUST , 20 14 , he/she presented to Maricopa County, for payment a claim for services rendered or supplies furnished during the month of AUGUST , said claim being in the sum of ONE HUNDRED FIFTEEN AND NO/100 Dollars ($ 115.00 ) in payment of which the Board of Supervisors caused the Warrant No. 22219299 to be issued on SEPTEMBER ,20 14 , drawn on the Payroll Clearing Account fund. 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. Under penalty of perjury, affiant hereby affirms that this claim is correct and the amount shown is due and owing. WHEREFORE, affiant requests that the Board of Supervisors issue to him/her a duplicate of said Warrant No. 22219299 In the sum of $ 115.00 Dated: cc 2.t&9 la, 20 / hr'. Signed: J Affiant Ere-creattcrxiuron —Eeplaeoftreftt-cfretrir Subscribed and sworn to before me this ay_of Se,Pt , 20 1---S My commission expires: Notary Publics Martcopa County, Arizona MY Comm. Expires 08-19-17 UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO: Name: MYRNA ELLEN AU MAN Telephone Number: 623-742-9434 Address: 10134W ILLINI ST Employee ID #: 8 1 1 1 7 511— Address: TOLLESON AZ 85353 01/31/2013 INTEROFFICE MEMORANDUM Maricopa County Education Service Agency (aka Maricopa County Superintendent of Schools Office) RECEIVED TO. CLERK OF THE BOARD SEP 2 4 2015 FROM. Denise Weihe MARICOPA COUNTY SUBJECT. Affidavits — Replacement of Lost Warrants CLERK BOARD OF SUPERVISORS /(:). YV/0/1/ DATE. 9/23/2015 Please find attached 7 Affidavit/Notice of Claim(s) for lost warrants for inclusion on the next available Board agenda The attached item(s) have been researched to ensure that the warrant(s) in question have not been cashed or previously re-issued. 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 clenise.weihe@mcesasnaricopa.gov . Approved Affidavits may be routed back to the Superintendent of Schools Finance Division at 4041 N. Central Avenue #1200, (12th Floor) Thank you. #59 Laveen Theresa Dowling $1436.98 #59 Laveen Theresa Dowling $1597.23 #59 Laveen Theresa Dowling $1360.52 #59 Laveen Theresa Dowling $1360.52 #59 Laveen Theresa Dowling $1384.52 #59 Laveen Theresa Dowling $1384.52 #214 Tolleson Dancewear/Kevin Schaller $167.70 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: Er Duplicate or 11 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. Theresa Dowling (1), being first sworn, upon oath deposes and says: Name/Claimant On or about September 25, 2014 Oate)(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 $ 1,384.52 .( 3) Signed: (4) Note: Please attach a col*-6f the warrant/check if available and/or any other evidence that a warrant/check was originally issued. (5) Subscribed and sworn to before me this \ UP4's day of Serj".' er-- 20 I-S NOTARY PUBLIC KAPLA AMES. Notary Public,State of Afizona Maricopa County My commission expires: My October Commission 30, Expires 2015 D (.3-p 64,- 2o 2.01S 1.11I1•71 (seal) Warrant/Check Number 150013290 (if known) (6) Original Date of Issue 9/25/2014 (if known) (7) le it' Reason for original issue of Warrant/Check (8): SEP El Payroll DATE. e, .• , • 111 For Services or Goods furnished _:2014itailifinkarMIL ORS MARICOPA COUNTY I= I Treasurer's refund/payment 111 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 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: El Duplicate or El 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. Theresa Dowling (1), being first sworn, upon oath deposes and says: Name/Claimant On or about October 23, 2014 (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 $ 1,384.52 .(3) Signed: 7--/C)24-L-eit (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) Subscribed and sworn to before me this (0 44" day of Sepl-t.-,6er' 20 1 5 . NOTARY PUBLIC KARLA AMES-ORTIZ Notary Public,State of Arizona Maricopa County My commission expires: My October Commission 30, 2015 Expires Ocho bete- 30/ 20 ILS (seal) Warrant/Check Number 150023933 (if known) (6) Original Date of Issue 10/23/2014 (if known) (7) Reason for original issue of Warrant/Check (8): RI Payroll O For Services or Goods furnished O Treasurer's refund/payment O Other: S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc Revised April 2015 A.R.S. 11-632 & 11-694 AFF DAVIT 441. STATE OF ARIZONA COUNTY OF MAR1COPA m , being first duly sworn, upon oath deposes and says: That on on the \CI day of 206 , he presented to District of lvlaricopa County, Arizona, for payment, a claim for services rendered or supplies furnished during the month of <\)6,ne. 20 \5, said claim being in the sum of CreltitYkiltt Nctli rs (S\ (el 7+0 ) in payment of which the Superintendent of Schools caused his/her Warrant Number 1-1' ..COCk.)(611* to be issued on , k._.ksf\t,LI 20 drawn on the 8,c..) Fund of TWe Kiy),(V1k0A4\ District of Maricopa County, Arizona. CW\ Affiant further says that although '1e/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 M91414 in the sum of $ 11(5171f.), Signed: rcci-or 4 1— Subscribed and sworn to before me this iiin4 day o My commission expires: 17- • Fallowing approval pleas return this affidavit to the Mandopa County School Superintendents 0 rice. JACKLYN S. O'LEARY Notary Public - Notary Seal STATE OF MISSOURI St Louis Cit‘ My Commissio,' Expire:: d 2016 Commission # 12512628 MARICOPA COUNTY Department of Finance 301 West Jefferson, Ste 960 Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM Date: September 25, 2015 To: Clerk of the Board From: Beth Brown Department of Finance Subject: Affidavit — Replacement of Lost Warrant Please find attached affidavit for lost warrant to be included on the next available Board Agenda. • The attached item has been researched to ensure the warrant in question has not been cashed or previously re-issued. • The original warrant has a void/stale date/stop payment done. Please call me at 506-1329 if you have any questions. Please return the approved Affidavit to my attention in the Department of Finance, Suite 960. Thank you. Re: LL DECKER & ASSOCIATES INC RECEIVD SEP 25 2015 MARICOPA COUNTY CLERK BOARD OF SUPERVISORS V-1,24 ddiVerob Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: Duplicate or El 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 which is Dace 2 of this form. LL DECKER & ASSOCIATES INC (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 1 1 -Aug-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 • the sum of $6,450.00 .(3) Signed (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) Subscribed and sworn to before me this (2144 day of 20 NOTARY PUBLIC KATHLEEN M. ELDERS Notary Public - State of Arizona My commission expires: My MARICOPA Commission COUNTY Expires S - March 31, 2016 (seal) Warrant/Check Number 360003712 (if known) (6) Original Date of Issue 11-Aug-2015 (if known) (7) Reason for original issue of Warrant/Check (8): LI Payroll For Services or Goods furnished during the month of August 2015 El Treasurer's refund/payment El Other: APPROVED DAT SEP 52015 AP WIN/ / P--'K :CARD OF SUP RVISORS MARICOPA COUNTY LL DECKER & ASSOCIATES, INC. Helping Organizations Change September 21, 2015 Maricopa County Department of Finance Attn: Beth Brown 301 W Jefferson, Suite 960 Phoenix, AZ 85003 CORPORATE ACTION BY CONSENT OF THE BOARD OF DIRECTORS OF LL DECKER & ASSOCIATES, INC. As permitted by law, the undersigned Board of Directors, being all of the Board of Directors of the above corporation, unanimously approve, adopt and consent to the following Resolution of the Board of Directors of the LL Decker & Associates, Inc. and corporate action(s) without a meeting. AUTHORIZATION OF CORPORATE ACTION. The Officers are authorized to take all actions and to sign all documents reasonably needed to satisfy the Maricopa County Finance Department in reissuing a check number 360003712 that was lost when sent to a previous address of the corporation. NOW THEREFORE BE IT RESOLVED, that the President be authorized to enter into these transactions. ance L. Decker President Jeanine E Decker Secretary and Treasurer 77 East Missouri Avenue, Phoenix, Arizona 85012-1380 Telephone 602.957.9659 • E-mail ldecker@Ildecker.com tt) rIt 44: t3( 4.1 if) 1' 1 Maricopa County Human Resources Memo Tog Fran McCarroll, Clerk of the Board From: Wanda Childers Date: September 29, 2015 Re: Replacement of Lost Payroll Warrants Please find attached I Affidavit/Notice of Claim(s) for lost payroll warrants for inclusion on the next available Board agenda. The attached item(s) have been researched to ensure that the warrant(s) in question have not been cashed or previously re- issued. The original warrant(s) have had a stop payment done. Please call Wanda at ext. 60409 for any questions. Please route approved Affidavits back to County Payroll, Suite 220. Stale Dated Warrant Duplicate Warrant Thank you. 1.?a,2 T6'")-?••1 1'6i) YA/N 93 :01 WV 6Z d3S CIO? Replacement Lost Warrant Form 02/25/2015 :S.tIOSIAM3,111S A .1,Nno3 vdooid JO 08-V8-8 v1,1 ;48313 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for RI Duplicate or 0 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. Sara Smith (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 09/23/2015 (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 th,e sum of $ 943 .30 .(3) Signed: riAVi (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) Subscrib and sworn to before me this cY day of pr_a_j OTARY PUBLIC CARLA D. WAYMIRE My commission expires: % Notary Public - State of Arizona MARICOPA COUNTY / 6/c!2/)/(i My Commission Expires August 19, 201 seal) Warrant/Check Number 0022313779 (if known) (6) Original Date of Issue 09/23/2015 47, - (if known) (7) t-Jrn Reason for original issue of Warrant/Check (8): N.) Payroll -0 E For Services or Goods furnished .1> O Treasurer's refund/payment 4? E Other: C.3 APPitotifigo Revised April 2015 A.R.S. 11-632 84 11-644 SEL3 O CLERK, BOARD OF SUPERVISORS MARICOPA COUNTY Amy Echols - COSCX Subject: FW: Missing Paycheck From: Sara Smith - COSCX Sent: Tuesday, September 29, 2015 9:29 AM To: Amy Echols - COSCX Subject: RE: Missing Paycheck Hi Amy, I am requesting a new check because I did not receive the original check in the mail. Sincerely, Sara Smith 811120365 Smith,Sara P MCVNEX Paycheck View MCY-Earnings Taxes Deductions Garnishments Special Accumulators Distributions Name Smith,Sara P Confirmed Check Check14 Issue Date Earnings Taxes Deductions Net Pay 22313779 09/23/2015 1,281.60 191.30 147.00 943.30 Regularand Overtime Earnings --- Taxes Reg Hours Reg Pay OT Hours OT Pay FED SS/Dis EE 79.461 1 FED Medicare EE 18.581 40.00 640.80 FED Withholdng 93.261 ; 32.00 512.64 * FED SS/Dis ER 79.461 * FED MedicareER 18.58 r Other Earnings- 1 Code Hours Amounts Add to Gross 14 After-Tax 1.54 HPA 8.00 128.16 12 Before-Tax 145.46 52A Nontaxable 1.29 i 12 Nontaxable 145.46 I 14 Nontaxable 1.54 ADP Enterprise HR screen print as of: 09/2912015 09:51 AM Memo RECEIVED SEP 2 8 2015 To: Fran McCarroll, Clerk of the Board CLERK MARCOPA BOARD OF COUNTY SUPERVISORS From: Linda Widner Date: September 25, 2015 Re: Replacement of Lost Payroll Warrants Please find attached 1 Affidavit/Notice of Claim(s) for lost payroll warrants for inclusion on the next available Board agenda. The attached item(s) have been researched to ensure that the warrant(s) in question have not been cashed or previously re- issued. The original warrant(s) have had a stop payment done. Please call Linda W. at ext. 68051 for any questions. Please route approved Affidavits back to County Payroll, Suite 220. Stale Dated Warrant Duplicate Warrant Thank you. Replacement Lost Warrant Form 1 02/25/2015 APPil 0 VED DATE. SFP o 201 K, BOARD OF SUPERVISORS AFFIDAVIT/NOTICE OF CLAIM MARICOPA COUNTY 15 SEP 25 AM11: 14 STATE OF ARIZONA COUNTY OF MARICOPA HUMAN RESOURCES n BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on the I day of Se , 20 1 LS—, he/she presented to Maricopa County, for payment a claim for services rendered or supplies furnished during the month of Se YYN , said claim being in the sum of One —MbuSct y,-)cl kthwildrealionn Six4 Dollars ($ 12-2 (p.`" ) in payment of which the Board of Supervisors caused the Warrant No. 22:&(-4-0 -2—s— to be issued on , 2015 , drawn on the Payroll Clearing Account fund. 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. Under penalty of perjury, affiant hereby affirms that this claim is correct and the amount shown is due and owing. WHEREFORE, affiant requests that the Board of Supervisors issue to him/her a duplicate of said Warrant No. 223 1 1-107-c In the sum of $ 22-Cot, Dated: q -2-3 , 20 I Signed: file440- 6/ Affiant ***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the replacement check.*** Subscribed and sworn to before me this A-f day of Wkiyi‘er, 20 /LC Notary Public My co/ i mission expires: BILLIE BERRY Notary Public- MO Waits. MARICoPA COUNTY ? Aeo Nty Commission Expires Feb. tO, 2019 UPON A PROVAL, PLEASE MAIL REPLACEMENT CHECK TO: Name: Telephone Number: (dP1 "-- 6 S —01 51 Address: Address: 4/3/2012 ell 1 /572.0 / to 4)/L.1,\( 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. 9/29/2015 Please find attached 7 Affidavit/Notice of Claim(s) for lost warrants for inclusion on the next available Board agenda The attached item(s) have been researched to ensure that the warrant(s) in question have not been cashed or previously re-issued. 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, #60 Higley Neal Nunan $25.00 #60 Higley Neal Nunan $25.00 #216 Agua Fria Esau Munoz $317.36 #49 Palo Verde Justin Stanberry $56.07 #66 Roosevelt Ryan Menke $1270.63 #66 Roosevelt Thomas Spurlock $750.17 #47 Arlington Town of Buckeye $325 RECEIVED SEP 3 0 2015 MARICOPA COUNTY CLERK BARD OF SUPERVISORS t 1 0 mcu-Q, AFFIDAVIT STATE OF ARIZONA K. BOARD OF SuPERVISORS MARICOPA COUNTY COUNTY OF MARICOPA ecti kl Ocko , being first duly sworn, upon oath deposes and says: That on the -clav of i4--061 20)57- he presented to HiI 04/ C16'd 601(1 00 District of Maricopa County, Arizona, for payment, a claim for services rendered or supplies furnished during the month of To 20 I# said claim being in the sum of -1ADe41' --I( de_ Dollars, ($A57- 06 ) in payment of which the Superintendent of Schools caused his/her Warrant Number J s-biD:5 1-1 LI to be issued on Le - AS- , 20 /3 , drawn on the 693 Fundof 1-4-niftr I Ged) c_11 od 1 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 5b1 I Lig in the sum of $i)b . Signed: Subscribed and sworn to before me this Will day of Se/0/61theiT20 NOTARY PUBLIC My commission expires: otILIS 8?4, OFFICIAL SEAL Following approval please return this affidavit to the Mancops oblY1411kATIP*13Wicel Notary 'Public - State of Arizona st, AW, 4 MARICOPA COUNTY ! My Comm. Expires Sept. 17, 2016 ! AFFIDAVIT STATE OF ARIZONA bOARD OF SL r3VISORS MARICOPA COUNTY COUNTY OF MARICOPA Ne IJottr) , being first duly sworn, upon oath deposes and sa ys: That on the 3 dav of 4 Li 20157 he presented to 14'19e4 Unicied 56100 District of Maricopa Count y, Arizona, for pa yment, a claim for services rendered or supplies furnished durin g the month of OCT° 6 EC 20 1`), said claim being in the sum of TlA)Qn1-xt VP- Dollars, ($ CYO ) in payment of which the Superintendent of Schools caused his/her Warrant Number Li 5 00 1ILo to be issued on /0 - 1-3 , 20 /57drawn on the5O16— Fund of 1173.Iev Un cli,00 District of Maricopa Count y, Arizona. Affiant further sa ys that althou gh he/she was informed and believes that the above mentioned warrant was re g ularly issued, the same has never been received, or has been lost. WHEREFORE, affiant pra ys that the Board of Supervisors order and the Superintendent of Schools issue to him/her a duplicate of said Warrant Number ) (09 in the sum of $ 5: Da . Signed: Subscribed and sworn to before me this /kW' day of Se,kinber,20 NOTARY PUBLIC My COMITiission expires: 9// 1 ••II SEAL •••IIII •• II •• I •• I ly-0-FTIFIAL T ART I Following approval please return this affidavit to the Maricopa Cor V ora 6110A : MARICOPACOUNTY #4,e, My Comm. Expires Sept 17, 2016! 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. ESAU MUNOZ (1), being first sworn, upon oath deposes and says: Name/Claimant On or about q-23-15 (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 $ 317 . 36 .(3) Signed: (4) day of OFFICIAL SEAL Notary ANDREA Public L. - Stale CRAVVLEY of Arizona MARICOPA COUNTY I My Comm. Expires July 17, 2017 i (seal) Note: Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. I•I Warrant/Check Number (if known) (6) Original Date of Issue 9/10/2015 (if known) (7) =i1COPA /\D Q - COUNTY SUPERVISORS Reason for original issue of Warrant/Check (8): Payroll El For Services or Goods furnished PLEAS-ERE-1881-4E-ettEeK 0 Other: PLEASE RE-ISSUE CHECK 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 AFFIDAVIT STATE OF ARIZONA MAriICOrA c.;OUNTY COUNTY OF MARICOPA , being first duly sworn, upon oath deposes and says: That on the day of got-m.1201F) , he presented to 4) k) 41i-L4-q District of Maricopa County, Arizona, for payment, a claim for services rendered or supplies furnished during the month of VeiDruosti 20 15, said claim being in the sum of oal27/ CD Dollars, (th.L.Q1 J in payment of which the Superintendent of Schools caused his/her Warrant Number 4.5 0060160 to be issued on Ogli 0 , 20 L5, drawn on the _COL Fund of -pvEsi) 4-10 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. VVHEREFORE, affiant prays that the Board of Supervisors order and the Superintendent of Schools issue to him/her a duplicate of said Warrant Number _________ ri in the sum of t Signed: V Subscribed and sworn to before me this 11..0& day of ,203 TABITHA TREECE NOTARY PUBLI Wiry Public - Af1101111 My commission expires: 4 19 Moriccma EX9Ifes County Apr 9, 201 My Comm. Following approval please return this affidavit to the Maricopa County School Superintendents 0 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. Ryan Menke (1), being first sworn, upon oath deposes and says: Name/Claimant On or about e-1 1-5 (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 $ 1,27° a 63 .(3) (4) A.1-Y 7 before me thi7F-- day of LW:lewbeir20 15 . My coTmi4on expires: Maricopa Notary Public County State of Arizona 0-7/a3po /7 Raquel Robles (seal) My Commission Expires 07/03/2017 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 160006811 (if known) (6) Original (if Date of Issue 08/06/2015 DATA . 0Cf)91 1 20),, known) (7) Reason for original issue of Warrant/Check (8): 111 Payroll III For Services or Goods furnished VOther: LatS i'Vagled S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc Revised June 2015 A.R.S. 11-632 81.15-999 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 COUNTY OF MARICOPA Instruction sheet which is page 2 of this form. Thomas M. Spurlock (1), being first sworn, upon oath deposes and says: Name/Claimant On or about rvio/zots- (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 $ 750 . 17 .(3) Signed: *A, (4) to before me this 23 1:14) day of 3t/96cirie(20 /5 . Notary Public State of Arizona My coy iss7 expires: Raquel Maricopa Robles County 0-7 0 ,3 ‘ .0/.7 My Commission Expires 07/03/2017 (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 160019958 (if known) (6) Original Date of Issue 09/17/2015 (if known) (7) Reason for original issue of Warrant/Check (8): 0 Payroll 0 For Services or Goods furnished 11V6ther: 1(y-A ch(0,K 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 Affidavit STATE OF ARIZONA OCT 2015 COUNTY OF MARICOPA ) ./.2t4.10401 I 72f 7/J (2)-iN &ilk-eye being first duly sworn, upon oath deposes and says: That on the 074/ day of Vi/Zif e , 20_/5 he presented to the Art, (),471.0)7 0.1)&5/ -01 '517 of Maricopa County, for payment, a claim for services rendered or supplies furnished during the month of ZILL6 , said claim being in the sum of Dollars ($ k 7075 in payment of which the Superintendent of Schools caused his/her Warrant No. *A5 O07 3 Aci to be issued on chin'Az 6114/ , 20 /31 , drawn on thet5.3L Fund of tmectAbf.il of Maricopa County, Arizona. Affiant further says that although he 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 a duplicate of said warrant number -X5606.73 4 .5--S" in the sum of Subscribed and sworn before me this day of OFFICIAL SEAL c, MELANIE FINCHUM Ikur - State of Issizona MARCCOPA COUN-fY -rt_r!"-/ My Comm. Expires 41111, 2019 My Commission Expires Following approval please return this affidavit to the Maricopa County School Superintendent's Office. 1-1:\Work\Affidavit.doc 07/14105 COMMUNITY SERVICE DEPARTMENT BUCKEYE, AZ City of Buckeye, Arizona September 22, 2015 Arlington Elementary School 9410 S. 355th Ave. Arlington, AZ 85322 Dear Kathy Turner, The City of Buckeye Community Services Department database shows that Arlington School hosted a private pool rental at the Aquatic Center for an end of school year party on 5/14/15 from 9am-2pm. The party rental has an outstanding balance of $325.00. I, Jessica Thompson am authorized to sign on behalf of the City of Buckeye. Please make payment out to the City of Buckeye upon receipt of this notice. If you have any additional questions or concerns, please feel free to contact me. Kind regards, J4sica Thompson City of Buckeye Recreation Supervisor IthompsonPbuckeveaz.gov 623.349.6613 530 E Monroe Ave • Buckeye, Arizona 85326 Phone 623-349-6164 • Fax 623-349-6222 • www.buckeyeaz.gov