100715 STALE DATED WARRANTS.PDF

INTEROFFICE MEMORANDUM
_Maricopa County Education Service Agency (aka
Maricopa County Superintendent of Schools Office)
RECEIVED
TO; CLERK OF THE BOARD
SEP 24 2015
FROM. Denise Weihe
MARICOPA COUNTY
SUBJECT. Affidavits - Replacement of Lost Warrants CLERK BOARD OF SUPERVISORS
}/o mar)
DATE, 9/23/2015
Lo.
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 hada 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.zov. 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: LJ Duplicate or Ma 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 July 31, 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 $ 1,436.98 (3)
Vbrren Ast
Signed: (4)
ey.
Note, Please attach a 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 \* day of September 20 15.
NOTARY PUBLIC ¥
—— SS
My commission expires: ‘ By hiv Gooncic cuties |
October JO, 2015 Set October 30, 2015 j (seal)
Warrant/Check Number 08080
1401
(if known) (6)
Original Date of Issue
7/31/2014
(if known) (7)
Reason for original issue of Warrant/Check (8):
Payroll
LC 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

Application for a Duplicate or Stale-Dated Warrant/ Check
Affidavit/ Claim Form
This application is for: OC Duplicate or wl 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 August 14, 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 $ 1,597.23 (3)
Signed: g Ak Kuh (4) 4
B
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__|** day of Sepmber 2015.
EK,nYa Que -Oittes
My commission expires: Nee 6 eee
October Los ] Nas October 30, 2015 j (seal)
30,
Warrant/Check Number
150000990
(if known) (6)
Original Date of Issue
8/14/2014
(if known) (7)
Reason for original issue of Warrant/Check (8):
Payroll
O For Services or Goods furnished
(11 Treasurer's refund/payment
C1 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: CJ Duplicate or 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 August 28, 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. 5
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
a be issued to in the sum of $ 1,360.52 (3)
GL AOL
hx
Signed: Ki (4)
\
Please arrant/check
Note: attach a copy of the if available and/or any other
evidence that a warrant/check was originally issued.
(5) Subscribed and sworn to before me this__|&*** day of _Septerlb-er 20 15
PUBLIC Se a er eS
NOTARY
¢
eee
My commission expires:
Octobe 30,2015 (seal)
Warrant/Check Number 150005376
(if known) (6)
Original Date of Issue
8/28/2014
(if known) (7)
Reason for original issue of Warrant/Check (8):
Payroll
O For Services or Goods furnished
1 Treasurer's refund/payment
L] 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: CJ Duplicate or [X{ 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 9, 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 $ 1,360.52 (3)
V hrrcen Lip. S5,
Signed: (4)
C/
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__\l*_ day of _Septemloeer 20.15 .
Kas Cnar-Orcte,
NOTARY PUBLIC —= oo
My commission expires: WANES
y Exp
October 20'S ] <1 October 30,2015 4 (seal)
30,
[Warrant/Check Number ]459999035
(if known) (6)
Original Date of Issue
9/9/20 1 4
(if known) (7)
Reason for original issue of Warrant/Check (8):
Payroll
C For Services or Goods furnished
1 Treasurer’s refund/payment
[11 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