031115 MAIN DUPLICATE WARRANTS.PDF

INTEROFFICE MEMORANDUM
Waricopa County Education Service Agency (aka
Ataricopa County Superintendent of Schoory Office)
RECEIVED
TO: CLERK OF TJ -CE (BOARD
FEB 1 3 20i5
FROM: Willie Thompson
SUBJECT: Affidavits — Wfpfacement of Lost Warrants CLL; ,..1JARD T1COPA OF COUNTY SUPERVISORS
DATE: 2/11/2015
(Please find attached 6 Afficiavit/Arotice of Cfilim(s)for Cost warrants for inclusion on
the ne4 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, p lease contact Were Thompson at 506.3898 or via e-mail at
mdlie.thompson@mcesa.maricopa.gov . Approved Affidavits may be routed back to the
Superintendent of School Finance (Division at 4041 N. Central Avenue #1200, ( 12th
Tibor) Tfiankyou.
#21 WrORTY-PY A.AW01+1 LODES $586.86
#66 ROOSEVELT 17L91rET G SLAW - $813.55
#44 AVONDALE GA .1I1- OrOTOAC $700.00
#60 IfIGLET 911A,STERYVIATY 514E.WTOR $99.95
#31 MLSZ SOVT.VIWEST LAOWATOVES $171.50
#60 ifIGLET LEE W S012711WAT $944.10

AFFIDAVIT
STATE OF ARIZONA
COUNTY OF MARICOPA
being first duly sworn, upon oath deposes and says:
, +kk
That on the la, day of (20 he presented to litt)41 .C1(k -D14-
District of Maricopa County, Arizona, for payment, a claim for services rendered
or supplies furnished during the
month of C,edrx { 20 said claim being in the sum of
S6/6 0 ----
-Go kry wAr-Pj c liX Dollars, ($ in payment of which the
Superintendent of Schools caused his/her Warrant Number 1 5 0 3-7 ciq I to be
issued on OK Qin I jc-V-N\ , 20 i (v?, drawn on the 0 0-Fund of Q\irb(
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
37 1-iq I in the surrW
tiouzx eig1111• 1•1111•••I•••••I•••II•••••••
BARBARA GRACIA
Signed: Notary Pubilo • State ofAtizona
MARICOPACOUNT`f I
My Comm. Moires Sapt. to, Mai
Subscribed and sworn to -before me this
My commission expires:
Following approval phase rdiurn this affidavit to the Maricopa County School Superintendents Office.

STATE OF ARIZONA
COUNTY OF MARICOPA
being duly sworn, upon oath deposes and says;
That on the I to day of -7.3ctrvun 6.1 , 0-0.15 he/she presented to the
Treasurers of Maricopa County, for payment, a claim for services rendered or
supplies furnished during the month ofciyucr t , said claim being in the sum of
4%3' kurva r-Qd2 -44& Ofe-QA cto11ct ri '551.P dollars ($ 8-- ) in payment of which the
Superintendent of Schools caused his/her Warrant Number 1500 -4‘-i to be issued on
7,S(141AUC, I" , `DojS— , drawn on the ________ Fund of Treasurers of
Maricopa County, Arizona.
Claimant further says that although he/she was informed and believed that the above-
mentioned warrant was regularly issued, the same has never been received or has been lost.
Under penalty of perjury, claimant hereby affirms that this claim is correct and the amount
shown is due and owing.
Wherefore, claimant requests that the Board of Supervisors order and the Superintendent
of Schools issue him/her a duplicate of said Warrant Number )3c.)5li in the sum of
Claimant Signature
Subscribed and sworn before me this - , / daYo
Notary Public
SAMALA M. HENRY
Notary Public-State ofArizone
MARICOPA COUNTY My commission expires. Qc S.%
MY Commission Expires
November 5, 2015
Following approval please return this affidavit to Maricopa Courtly Education Service Agency.

A-17:1:LAI;,,V;itff V
AFFIDAVIT
K, BOARD OF SUPERVISORS
MARICOPA COUNTY
STATE OF ARIZONA
COUNTY OF MARICOPA
IV 1 0- TUv bL1--[-u 161 (!--- , being first duly sworn, upon oath deposes and says:
(Name and Title of Person)
That on 116-4 , 20 (4' , he/she presented to A4606LIL b19-1', of
(School District Name)
Maricopa County, Arizona, for payment, a claim for services rendered or supplies furnished during the
month of Ocs.3( , 20 (4' said claim being in the sum of ($ n 6°' O )
0—V a..N1 LA) Q.ck Dollars in payment of which
the Superintendent of Schools caused his/her Warrant Number 4-1/ 60 -6°16 to be issued
on ID t , , 20 (4, drawn on the 8° I Fund of Avm-y-Lit_ tit t-rn am_ .kca,-.1 Sellock tLof
(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 LF 6 °16 in the sum of $ ni rô. CO
Signed:
and Title of Authorized Personnel)
Subscribed and Sworn to before me this 34) k. day ci
40.'• • • • • • • GIMP • 1101.••••• • • • •••••••••• •
NOTARY PUBLIC: OFFICIAL SEAL
LAURA VERA I
My commission expires: i : Fitragg Notary Public - State ofArizona
MAR1COPA COUNTY
My Comm. Expires Aug . 31, 2017 I
Following approval please return this affidavit to the Maricopa Count y Education Service Agency Office.

APPROVE
, FEB1\7 2015
AFFIDAVIT
ETTK rris
MARICOPA COUNTY
STATE OF ARIZONA
COUNTY OF MARICOPA
1-,, C mer,to( , being first duly sworn, upon oath deposes and says:
That on the day of 5/-1/0 20 l& he presented to 14 03
District of Maricopa County, Arizona, for payment, a claim for services rendered
or supplies furnished during the
month of bee erylio.e,t 20 11, said claim being in the sum of
SON LA ' /10 Dollars, ($ qq. q5---) in payment of which the
off/
Superintendent of Schools caused his/her Warrant Number Ed C)C)1--M5 / 3 to be
issued on , 20 I, drawn on the (pit) Fund of RUSi) '°. ti9C)
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
L) r.) ObL i {.A 5/ 3 in the sum of $ qq. 957 CHARLES R. BOLICK
NOTARY PUBLIC
STATE OF FLORIDA
Commit EE188402
Signed: _ yo. Expires 4/23/2016
Subscribed and sworn to before me this y of (>2 5-
NOTARY PUBLIC
My commission expire 92 3 6140/6
Following approval please return this affidavit to the Maricopa County School Superintendents Office.

A PrROVED
FEB1 7 2015
AFFIDAVIT DA! ,
STATE OF ARIZONA
COUNTY OF MARICOPA
r /-416ainq riGtel6r being first duly sworn, upon oath deposes and says:
(Name and Title of Person)
That on .4 C./CT- • -3 , 20 , he/she presented to At9 4_3 a /7/60 L2 ks-r. 0.2/ of
(School District Name)
Maricopa County, Arizona, for payment, a claim for services rendered or supplies furnished during the
month of A.../ Cr LIST' , 20. /`" , said claim being in the sum of ($ / /, SO )
Joe -1-114 to °KW t,f6-e_.)EILati- fietJe 61-0a- Sy /60 — Dollars in payment of which
the Superintendent of Schools caused his/her Warrant Number <757) O / / 6 Ca 1 to be issued
on jeir27-- , 20 tv , drawn on the 00/ Fund of AcY–S cSIC,0150 #3/ 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 9..1-0 6 // ' l7 in the sum of $ / 7 1. SD .
Signed — v1?1i4-7( Acre
(Name and Title of Authorized Per o el
Subscribed and sworn to before me this nn _L_L day of 6.4viutt , 20 1S
NOTARY PUBLIC:
My commission expires:
My Commission Expires
02-04-2017 -
Following approval please return this affidavit to the Maricopa County Education Service Agency Office.

A P P
AFFIDAVIT DATEA FEB
m-B"tk. pAiciiD opOl AF4GS-06:1-"t\L7 1 c'bUti$
State of Arizona }
County of Maricopal
being first duly sworn, upon oath deposes and says:
day of , 20 , he presented to Higley
-That on the
School District #60 of Maricopa County, for payment, a claim for services
Unified
rendered or supplies furnished during the month of , said claim
-
in the sum of Litlicjipaie,/v,4 14,yi a_0 1'710-D - Dollars ($ rcp-/ I-" ) in payment
being
Higley Unified School District #60 caused Warrant No. / MC to be
in which
, 20 , drawn on the /)- Fund of
issued on
Higley Unified School District #60 of Maricopa County, Arizona.
Affiant further says that although he was informed and believes received, that the above or has
mentioned warrant was regularly issued, the same has never been
been lost.
affiant prays that the Board of Supervisors order and the Maricopa
WHEREFORE, Superintendent issue to him a duplicate of said Warrant No.
County
In the sum of $
(111/: "cd4/14""7
Signature
and sworn before me this 30 day of LiarIi,(Cali , 20 /ST
Subscribd
My Commission Expires // 7//0
Following approval please return this affidavit to County Schools Office
OFFICIAL SEAL
: Notaty LYNETTE Public - STEVVART State of Arizona ;
! MARICOPA COUNTY
i # my Comal, Expires Sapt. 17, 20181
9,111.,11,

MARICOPA COUNTY
Department of Finance
301 West Jefferson, Ste 960
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
Date: February 12, 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: TAYLOR AND ASSOCIATES
ON BEHALF OF CAROLYN STEINER
RECE WED
FEB 1 2 2 015
MAOPA GUAM'
CLERK BOARD OF SUPERVISORS

RECEIVED
FEB 0 5 2015
RISK MANAGEMENT
AFFIDAVIT
APPROVIED
STATE OF ARIZONA,
COUNTY OF MARICOPA
Ppm n moil.* er5 being first sworn, upon oath deposes and says:
That on the 21s t day of January, 2015, Maricopa County agreed to an Indemnity
payment on behalf of our client Carolyn Steiner, in the sum of Six hundred six
dollars and eighty-eight cents, ($ 606.88) in payment of which the Board of
Supervisors caused the Warrant No.AD 00350017999 to be issued on January
21, 2015, drawn on the Expense Fund.
Affiant further say that although they were informed and believe that the above
mentioned warrant was regularly issued, the same has never been received, or
has been lost.
Wherefore, affiants pray that the Board of Supervisors issue to them a duplicate
of said Warrant No.AD 00350017999 in the sum of $606.88
Agx
Signed: (1604#, filtilot
p)oot._
Subscribed and sworn to before me this day of t
CL6iivr
NOTARY PUBLIC
My commission expires: ffaniAcn, 11 1 2-0 n
Return original signed, notarized form to:
Maricopa County-Risk Management Dept.
234 N. Central Ave. Ste 530
Phoenix, AZ 85004

MARICOPA COUNTY
Department of Finance
301 West Jefferson, Ste 960
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
Date: February 20, 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: GEORGETOWN UNIVERSITY
RECEIVED
FEB 2 0 2015
MARIG(X.Y\ COUNTY
CLERK BOARD OF SUPERVISORS

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: Duplicate or 0 Stale-Dated (definitions are on page 2)
STATE OF ARIZONA Note: Numbers on this form correspond to
COUNTY OF MAR ICOPA numbers on the Instruction sheet which is
Dace 2 of this form.
GEORGETOWN UNIVERSITY (1), being 'first sworn, upon oath deposes and says:
Name/Claimant
On or about 10-Oct-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 $3,500.00 .(3)
Signed: frc zjr 0/1s (4)
Note: lease 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 "oe. Clay 20417
OTARY PUBLIC
JOHN I...WILLIAMSON
My commissio,n expires: NOTARY My Commission PUBUC DISTRICT Expires March OF COLUMBIA 31, 2019
Warrant/Check Number 350008893 ap ,, t/7 ,,,,, 1ItA •
(if known) (6)
Original Date of Issue 10-Oct-2014
(if known) (7)
Reason for original issue of Warrant/Check (8):
IA Payroll
For Services or Goods furnished during the month of November 2014
0 Treasurer's refund/payment
0 Other:
2PROVED
FEB 2_3 2015
o I
'CLERK 3 OF -`A THE BOARD S

MAR1COPA COUNTY
Department of Finance
301 West Jefferson, Ste 960
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
Date: February 20, 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: GEORGETOWN UNIVERSITY
RECEIVED
FEB 20 2015
MARIC(PA -30UNTY
CLERK BOARD OF SUPERVISORS

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: Duplicate or 0 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
cape 2 of this form.
GEORGETOWN UNIVERSITY (1), being 'first sworn, upon oath deposes and says:
Name/Claimant
On or about 29 -Sep -201 4 (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 $ 7,000.00 .(3)
Signed: (4)
Note: efease 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 6th day of February 20 15
r,) ....... A013/
••
Y PUBLIC JOHN L. WILLIAMSON
My commission expires:
March 31, 2019
Warrant/Check Number 350007829
(if known) (6)
29-Sep-2014
Reason for original issue of Warrant/Check (8):
111 Payroll
For Services or Goods furnished during the month of November 2014
0 Treasurer's refund/payment
0 Other:
a 1: ° FEBV2 E20D15
11_,LA4
CLF,f2K OE TH

MARICOPA COUNTY
Department of Finance
301 West Jefferson, Ste 960
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
Date: February 20, 2015
To: Clerk of the Board
From: Joyce Maumnann
Department of Finance
Subject: Affidavits — Replacement of Lost Warrants
Please find attached 1 Affidavits for lost warrants to be included on the next available
Board Agenda.
• The attached items have been researched to ensure the warrant in
question have not been cashed or previously re-issued.
• The original warrants have a void/stale date/stop payment done.
Please call me at 506-1343 if you have any questions. Please return the approved
Affidavits to my attention in the Department of Finance, Suite 960.
Thank you.
Re: Staples
RECEIVED
FEB 2 0 2015
MANCOPA ...;OUNTY
CLERK BOARD OF SUPERVISORS

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: Duplicate or ID 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
page 2 of this form.
Staples (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 06-Nov-2014 (crate)(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 t he sum of $ 3,236.92 .(3)
Signed: (4)
Note: Please attach a copy 'f 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 q"\e'r• dayof ---WA-)&!CA9 20 15 .
At UtirA ' ' ' - Cc ),^c\KWed ,(15
NOTARY PUBLIC LCA, krnaky-0..cidr3 N CILAV--R
My commission expires:
ca\a<6 \ t Laura Pasyrovitz IrSor Mavrryi ,7 v (sal) ;
NOTARY PUBLId4OTAF
Warrant/Check Number 350011237 kycammissionepillilrier2o1a
(if known) (6)
Original Date of Issue 06-Nov-2014
(if known) (7)
Reason for original issue of Warrant/Check (8):
171 Payroll
111 For Services or Goods furnished
Treasurer's refund/payment
171 Other:
FEB 2 3 2015
CLERK OF TH ReAn{g) , iS
' Y

. CLERK
MAR1COPA COUNTY BOARD OF SUPERVISOR'S
Department of Finance P1A JCOpA COM' Y
301 West Jefferson, Ste 960 2015 FEB 23 Ptil I:3
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
Date: February 23, 2015
To: Clerk of the Board
From: Kathy Baskom
Department of Finance
Subject: Affidavits — Replacement of Lost Warrants
Please find attached 1 Affidavits for lost warrants to be included on the next available
Board Agenda.
• The attached items have been researched to ensure the warrant in
question have not been cashed or previously re-issued.
• The original warrants have a void/stale date/stop payment done.
Please call me at 506-0572 if you have any questions. Please return the approved
Affidavits to my attention in the Department of Finance, Suite 960.
Thank you.
Re: State Farm Fire & Casualty
-(
KR+K
)
(5°57Z
FTAl

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
MANAGEMENT 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
bacie 2 of this form.
RISK State Farm (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 23 - Oct-20 14 (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 Wher_in the _sum of_s_5,810.43 . (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 /5t1l day of ,fidgv2. 20/5 .
NOTARY Pl.] (_ OFFICIAL SEAL
JOYCE E. MEYER
My commission expires: MURRY MAR1COPA PUBLIC COUNTY - ARIZONA
, .a fC_,, My Comm. Expres szsgsgs;sS:6395 Jan. 120te (seal)
Warrant/Check Number 00350009867
(if known) (6)
Original Date of Issue 23-Oct-2014
(if known) (7)
Reason for original issue of Warrant/Check (8):
CI Payroll
Eli For Services or Goods furnished
LI Treasurer's refund/payment
Other: Settlement of AL5005041042089 State Farm
APPROVED
FEB Z4 21315
TE
LERK, BOARD OF SUPERVISOR ,
MARICOPA COUNTY

RECEVE
INTEROFFICE MEMORANDUM FEB 2 4 2015
Nry
Waricopa County Education Service Agency (aka CLERK BOARD OF SUPERVISORS
Maricopa County Superintendent of Schoo& Office)
TO: CLERK OF VIE WOARD
FROM: Willie 'Thompson
SUBJECT: Affidavits — Wcpfacement of Lost Warrants
DATE: 2/23/2015
Tkase find attached 7 Affidavit/Yotice of Claim(s)for lost 'warrants for inclusion on
the nekt availa6lTe Ooard agenda
.q The attached item(s) have 6een researched to ensure that the warrant(s) in
question have not 6een cashed or previously re-issued.
NI The original warrant(s) have had a stop payment done.
if you have any questions, p lease contact Willie Thompson at 506,3898 or via e-maiC at
miCrie.thompson@mcesa.maricopa.gov . Approved Affidavits may 6e routed 6ack,to the
Superintendent of School" Finance Division at 4041 X Central Avenue #1200, (12'n
Floor) Thankyou.
# 781 GAWS.7 -04E9VT LATORRET Win MD $435.00
/ #781 GAWIS.7114ENT .11,7I3r .7101XACKI $276,45
/#79 LPTCYIEILED 9111CNELLE ZORGER $88.30
/ #31 OALSZ OLI9VG ROClar SISTERS' $567.09
#65 LITILETOX WO 9V R3MIREZ $426.29
/#68 ilL.71:3911AA WILLIE n OLE TRODVCE $21311.85
/ #68 AL,909140R4 14AILI9V -GS DIRECT $1234.44

A P PR 0 V IC
STATE OF ARIZONA Eti 24 2015
COUNTY OF MARICOPA
MiVr"-If CC:PA COUNTY
ANN HOJNACKI being duly sworn, upon oath deposes and says;
That on the 9TH day of FEBRUARY 2015 he/she presented to the
Treasurers of Maricopa County, for payment, a claim for services rendered or
supplies furnished during the month of JANUARY said claim being in the sum of
TWO HUNDRED SEVENTY SIX DOLLARS AND 461100 dollars ($ 276.45 ) in payment of which the
Superintendent of Schools caused his/her Warrant Number 150047838 to be issued on
JANUARY 9TH 2015 , drawn on the 781 Fund of Treasurers of
Maricopa County, Arizona.
Claimant farther says that although he/she was informed and believed that the above-
mentioned warrant was regularly issued, the same has never been received or has been lost.
Under penalty of perjury, claimant hereby affirms that this claim is correct and the amount
shown is due and owing.
Wherefore, claimant requests that the Board of Supervisors order and the Superintendent
of Schools issue him/her a duplicate of said Warrant Number 150047838 in the sum of
276.45
Claimant Signature 41-1.1 AA 14‘4 4-
Subscribed and sworn before me this /3 day of
0 a. OFIE:6.4;'4"...
0 0 E.: 1,71.
My commission expires
v„„619,6Af ,
Following approval please return this affidavit to Maricopa County Education Service Agency.

LITCHFIELD ELEMENTARY SCHOOL DISTRICT
272 East Sagebrush Street 0 Litchfield Park, Arizona 85340 - 623.535.6000 Fax 623.935.1448 www.lesd.k12.az.us
"A StrongeApifii5 cikStrvoilier Future"
STATE OF ARIZONA } LERK. BOARD OF SUPERVISORS
ss. CC PA COUNTY
COUNTY OF MARICOPA }
Michelle Zorger being first duly sworn, upon oath deposes and says:
That on the 12th of Dec, 2014 she 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 Nov
& Dec 2014, said claim being in the sum of Eighty Eight and 30/100
Dollars ($88.30.) in payment of which the Superintendent of Schools
caused Warrant No. 4-5-0051699 to be issued on January 13, 2015. drawn
on the Teacher Travel 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 Michelle Zoger a duplicate of said
Warrant No. 4-5-0051699 in the sum of $88.30.
Payee Signature
Subscribed and sworn to before me this day of rehrtAi y/ 9,01S-
Notary "Public
My commission expires: on( s
Following approval, please return this affidavit to Maricopa County
Superintendent's office.
BRITTANY CARTER
Notary Public - Arizona
Maricopa County
My Comm. Expires Apr 29, 2015

APPROVED
EB 2A 2015
AFFIDAVIT
LERK BOARD OF SUPERVISORS
MARICOPA COUNTY
STATE OF ARIZONA
COUNTY OF MARICOPA
1`3 0C-A<K) 1 S1 ,ST- E..4C4 being first duly sworn, upon oath deposes and says:
(Name and Title of Person)
That on Ti. ,20 Ji , he/she presented to 6Pa,52 SCp-Mca . gp- 31 of
(School District Name)
Maricopa County, Arizona, for payment, a claim for services rendered or supplies furnished during the
month of clint 61 Li , 20 JS, said claim being in the sum of ($ . 0 5 )
rl a s. 0 if t 7( ^ Es•- a_nC-Q— °Y./16 0 Dollars in payment of which
the Superintendent of Schools caused his/her Warrant Number .5(_50O 5/9921g, to be issued
on , 20 13 , drawn on the _5624 Fund of 6P)L.5z. NSC f-t6u-- bier. 03( of
(School District Name)
Maricopa County, Arizona.
Affiant further says that although he r/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 '41 SG 0 YF95-A in the sum of $ 5C.01. O .
'
Signed:
(Name and Title of Authorized Perionnel) n,
Subscribed and sworn to before me this I 1 day of RbriA 20
NOTARY PUBLIC: / 77)Vall CATHERINE R. MONIALOO
*WY PA RICOPA Palk- Steteofkkon COUN
My commission expires: 77/ 5-7A2(5 (q My January Cornanaribn 18, Emnim TY
Following approval please return this affidavit to the Maricopa County Education Service Agency Office.

APPROVED
FEB ; 74 2015
DA
AFFIDAVIT BOARD OF SUPERVISORS
MAR$COPA COUNTY
STATE OF ARIZONA
COUNTY OF MARICOPA
* 11", e (Pftrix, being first duly sworn, upon oath deposes and says:
(name and title of person )*
That on the }2:). day of 20 )S-,, he/she presented to RI \f""`PfT)61-4-1
District of Maricopa County, Arizona , for payment, a claim for services rendered or supplies furnished
during the month of 20 I\S" , said claim being In the sum of ($ 1 1 (190):C
.c\o..se-cI C.V.AW
;eIC\ Dollars in payment of
Which the Superintendent of Schools caused his/her Warrant Number CI -SLC.Yx.9(.4(- 12._ to be
Issued on the 'Oc-s._X---o-s Y31‘,;20 ‘,c, drawn on thealo Fund of 19-111\om(),(----,
District of Maricopa County , Arizona,
Afflant 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 Supprvisors order and the Superintendent of Schools issue
to him/her a duplicate of said Warrant Number "- I -fc-naS— KAP in the sum of
STRAllINSKI
NOTARY PUBLIC, ARIZONA
Signed:** MARICOPA COUNTY
My Commission Expires
(Name 114 title of authorized personnel)** Apri110, 2018
Subscribed and sworn to before me this f3 day of FE6e-A-0-17-4, 20 f
NOTARY PUBLIC :
My commission expirTs: - Zolg
Following approval please return this affidavit to the Maricopa County Education Service Agency Office.

AP PROVED
DATE FE 2 4 2015
AFFIDAVIT 13 D
MARIC0P—A • CotiNcTY 111
STATE OF ARIZONA
COUNTY OF MARICOPA
* Mce, r-Svec. , being first duly sworn, upon oath deposes and says:
(name and title of person )* ri e. _pcvvitne.„,
That on the ci -IN\ day of 20 ILI , he/she presented to
District of Maricopa County, Arizona , for payment a claim for services rendered or supplies furnished
during the month of .10( ,...%2SINlie-f20 ) (1 , said claim being in the sum of ($ ){2 ,3c1.91 )
--\N-NCMNIch(A "\-k-DO 11-y-y-3\ Yet4 "- Do6rs In payment of
Which the Superintendent of Schools caused his/her Warrant Number ./--S—Cd(c,Q,2_ to be
Issued on the ILTeMg,r- —0320 v.4, drawn on the Cf--10,Fund of -n-yy:(vc--,
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_new been received, or has been lost.
WHEREFORE, affiant vAys)t‘--the Boar?1 of Supervisors order and the Superintendent of Schools issue
to him/her a cluplic9re of (aid Warre4 Number q— In the sum of $ 1 Z.3c1. .
Signed:**
ed069,0:3
I Mahn & title of authorizAd perscilinel **
Subskibed and sworn to before me this ?- day of Ft6 , 20
NOTARY PUBLIC
NOTARY PUBLIC : F ARIZONA
Maricopa Count
My commission commission expires: ogJZ //I PATTY J. VALONE
_y_42 Int Expires 08/12/16
rollowing approval please return this affidavit to the Maricopa County education Service Agency Office.

(SZ rtni/k
CLERK
Maricopa County 'BOARD MARICOPA OF SUPER COUNTY VISOR'S
Human Resources Department
21115 FEB 26 PH 3: 22
Payroll & Employee
Records Division
301 West Jefferson Street
Suite 220
Phoenix, AZ 85003-2143
Phone: 602-506-35 l 9 Memo
Payroll Fax: 602-372-0277
Records Fax: (102-506-5509
\invw.maricopa.gov
To: Fran McCarroll, Clerk of the Board
From: Wanda Childers
Date: February 26, 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 Wanda at x 6-0409 for any questions. Please
route approved Affidavits back to County Payroll, Suite 220.
Thank you.

APPROVED
EB 2 7_ 2015
AFFIDAVIT/NOTICE OF CLAIM
STATE OF ARIZONA 2015 FEB 23 PM 14: 25
COUNTY OF MARICOPA MAIMOPA COUNTY
DEPT. OF ELECTIONS
SHREYA RHEA LAMBA BEING FIRST DULY SWORN
OATH, DEPOSES AND SAYS:
That on the 4TH day of NOVEMBER , 20 14 , he/she presented
to Maricopa County, for payment a claim for services rendered or supplies furnished during the
month of NOVEMBER , said claim being in the sum of
ONE HUNDRED FIFTEEN and 00/100
Dollars ($ 115.00 ) in payment of which the Board of Supervisors caused the
Warrant No. 22239976 to be issued on DECEMBER 3 , 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 sai4
Warrant No. 22239976 In the sum of $ 115.00
Dated: 2- \ , 20 \ 5 Signed:
104ee-for4h-e-sten-navnent-and-reissatance-of-the-warrant-will-he-dedueted4rom4he
replacement -cheek.***
Subscribed and sworn to before me thi day of
Notary Public
My commission expires: Ranae McGinn
Notary Public
314.1 221 201 2. Maricopa County, Arizona
UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO: My Comm. Expires 07-22-18
01/31/2013

MARICOPA COUNTY
Department of Finance
301 West Jefferson, Ste 960
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
Date: March 3, 2015
To: Clerk of the Board
From: Joyce Maurmann
Department of Finance
Subject: Affidavits — Replacement of Lost Warrants
Please find attached 2 Affidavits for lost warrants to be included on the next available
Board Agenda.
• The attached items have been researched to ensure the warrant in
question have not been cashed or previously re-issued.
• The original warrants have a void/stale date/stop payment done.
Please call me at 506-1343 if you have any questions. Please return the approved
Affidavits to my attention in the Department of Finance, Suite 960.
Thank you.
Re: Cellebrite USA Inc
Arizona Construction Estimates
RECEIVED
MAR 0 3 2015
MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for 15I Duplicate or 0 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
page 2 of this form.
Cellebrite USA Inc (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 19-Nov-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/chec /her in the sum of $ 20,992.93 .(3)
Signed:( (4)
Note: Obese 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 20 .
:1(71,-w
NOTARY PUBLIC
JCilIN BIGLER
My commission expires. WARY PUBLIC OF NEW JERSEY
1.0. # 2346 193
My Crimminsion Expires 712112016 (seal)
Warrant/Check Number 350012570
(if known) (6)
Original Date of Issue 19-Nov-2014
(if known) (7)
Reason for original issue of Warrant/Check (8):
Payroll
Ti For Services or Goods furnished
D Treasurer's refund/payment
El Other:
V E I)
03 2015
MK, BOAFID OF SUPERVISORS
MAR4COPA _ COUNTY _

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: Duplicate or 0 Stale-Dated (definitions are on page 2)
STATE OF ARIZONA N ote: Numbers on this form correspond to
COUNTY OF MARICOPA numbers on the Instruction sheet which is
page 2 of this form.
ARIZONA CONSTRUCTION ESTIMATES (1), being first sworn, upon oath deposes and says:
Name/c1ã
On or about 26-Jan-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 e issued to him/her in the sum of $1,975.00 .(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) Subs Eyed and sworn to before me this kV *. day of 0,13, 20_1 5
A
NOTARY PUBLIC
"OFFICIAL SEAL"
My cornTirion expires: Susan L. Thompson
u Notary Public - Arizona
Maricopa County (seal)
My Commission Exprres 5111/2015 .......
Warrant/Check Number 350018843
(if known) (6)
Original Date of Issue 26-Jan-2015
(if known) (7)
Reason for original issue of Warrant/Check (8):
El Payroll
For Services or Goods furnished
LI Treasurer's refund/payment
111 Other:

Maricopa County
Human Resources
Memo
To: Fran McCarroll, Clerk of the Board
From: Linda Widner
Date: March 2, 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 Widner at ext. 6-8051 for any questions. Please
route approved Affidavits back to County Payroll, Suite 220.
Stale Dated Warrant ( Duplicate Warrant
Thank you.
FECENED
MAR 0 2 2015
mAnicoRt,,
CLERK BOA!'0 OF SUPERVISORS

APPROVED
MA11 0 3 2015
AFFIDAVIT/NOTICE OF CLAIM
RK. BOARD O'F
MARICOPA COUNTY
STATE OF AR12ONA
COUNTY OF MAR1COPA
BELNQ FIRST DULY SWORN
NEL. F .
OATH, DEPOSES AND SAYS:
That on the _2nd day of _March , 2015 he/she presented
to Maricopa County, for payment a claim for services rendered or supplies furnished during the
, said claim being in the sum of
month of February 2015
One thousand six hundred ninety two and 21/100
($1,692,21__________) in payment of which the Board of Supervisors caused the
Dollars
No 22260791_ to be issued on 2/25/2015 drawn on the
Warrant
Payroll Clearing Account fund.
Afflant thither says that although he/she was informed and believes that the above mentioned of
warrant was regularly issued, the same has never been received, or has been lost. Under penalty owing.
perjury, affiant hereby affirms that this claim is correct and the amount shown is due and
WHEREFORE, affiant requests that the Board of Supervisors issue to him/her a duplicate orsaid
Warrant No 22260791_ In the sum of $1,692.21
Dated: 20_,S Signed:
Affiant
manee-of46e4v-affalitv.4111e-decitteted-liem4he
tia46.44-2,41)4ec 11-0-Siefkla
teplaeeateRt-eiteigfrtith-
Subscribed and sworn to before me this 9•"41( day of Wai , 20
4101
Notar) Public JUDY LEE SPEARS
My commission expires: NotzaParciastifievion cower
my Coardlegion acplow
Amp 7. 2010
LIPilsLAPPROVAL. PLEASE (4, MAIL REPLACEMENT CHECK TO:

INTEROFFICE MEMORANDUM
911aricopa County Education Service Agency (aka
Maricopa County Superintendent of Scfiogs Office)
TO: CLER11OEWE OARD RECEIVED
FROM: Willie Thompson MAR 0 2 Z015
SUBJECT: Affidavits — RcpCacentent af Lost Warrants IviARIC:;01,A or OOUNIY
CLERK BOA 1,7',711NIGORS
DATE: 2/27/2015
Pase find attached 5 Affidavit/Watke of Claim(s)for Cost warrants for inclusion on
the noct avaiCa6 Ooard agenda
The attached item(s) have been researched- to ensure that the warrant(s) in
question have not Seen cashed or previously re-issued
The original- wan-ant(s) have had a stop payment done.
If you have any questions, please contact Wiffie Thompson at 506.3898 or via e-mail at
millie.thompson@mcesa,maricopa.gov . _Approved Affidavits may Se routed - 6ackto the
Superintendent of School finance Division at 4041 X. Central Avenue #1200, ( 12th
Troor) Thankyou.
# I Of0EXIX EL AIRE FILE PRODrOCTS $1623.09
#1 Of0ENIX EL SIX POINTS YOUWARE ELECTRIC $121.19
#95 QUEEX CREEK, COAD EILER5 $249.34
# 781 gigivasifgvrEgvrr LAToRRETWAITEAD $435,00
#65 L,r1t1LETON MVO MM9IIREZ $426.29

AFFIDAVIT
RECEVED
APPROVED
DATE, MA1A 03 2015 FEB 13 2015
STATE OF ARIZONA
ACCTS. PAYABLE
si P ci
MARICOPA COUNTY
COUNTY OF MARICOPA
Aire Filter Products being first duly sworn, upon oath deposes and says:
That on the 21st, November 2014 presented to PHOENIX ELEMENTARY
SCHOOL DISTRICT #1 of Maricopa County, for payment, a claim for services
rendered or supplies furnished during the month of November 2014, said claim
being in the sum of $1623.09 in payment of which Superintendent of Schools
caused his/her Warrant No. 45-0037845 to be issued on, drawn on the 001
Fund of PHOENLY 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. 45-
0037845 in the sum of $1623.09.
74311101/17tW , Covik iX
Oruiro
Signature
Subscribed and sworn before me this lc) I ALVI\ day of . 20 IS
-ActaiktrA-)
Notary Public
My Commission Expires ' 1 S IZO 1?
Following approval please return this affidavit to COUNTY SCHOOLS OFFICE
VICTORIA HAMILTON
Notary Public - Arizona
Maricopa County
Expires 05/15/2018

APPROVED
DAT MA 3 2015
AFFIDAVIT
K, BOARD OF SUPERVISORS
MAFOCOPA COUNTY
STATE OF ARIZONA
COUNTY OF MA RICOPA
Six Points Hardware Elec being first duly sworn, upon oath deposes and says:
That on the 10th, November 2014 presented to PHOENIX ELEMENTARY
SCHOOL DISTRICT #1 of Maricopa County, for payment, a claim for services
rendered or supplies furnished during the month of October 2014, said claim
being in the sum of $121.19 in payment of which Superintendent of Schools
caused his/her Warrant No. 45 -0033480 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 saict Wtrrant No. 45-
0033480 in the sum of $121.19.
Signature 11-o__Gouvvievl 144Ar
Subscribed and and sworn before me this :3C) day of Ixn ctA ,203.5.
----01-7)FiriTere—A— ) MAR
Nosy Mc -WAN COMM
101ARICOPACOMY
Notary Public My Cixtimiolon AO 15, Evros
Ivry
Following approval please return this affidavit to COUNTY SCHOOLS OFFICE

APPRov 7
AFFIDAVIT
STATE OF ARIZONA
COUNTY OF MARICOPA
Chnd Q53 , being first duly sworn, upon oath deposes and says:
That on the 14 day of' -e-b 20 he presented toCcajeflia.a_____Q.S
District of Maricopa County, Arizona, for payment, a claim for services rendered
or supplies furnished during the
month of 'i3cUo.(U 20 t 5, said claim being in the sum of
aWoht.mAci- fed bfrk-tivla s lotrs, ($ 2 ) in payment of which the
Superintendent of Schools caused his/her Warrant Number I Sj3 572 *E0 to be
issued on c'2 1 19 , 2o1E, drawn on the COI Fund of 00.-U SD
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
..S-015 8-4 2 RI in the sum of $ .
Signed:
Subscribed and sworn to before me this 73 114 day of
SANDRA K NELSON
Notay Public - Su* of Arbcna
P1NA1. COUNTY
Nfry Commission Expires 3
September 25, 2015
oTARY PUBLIC
My commission expires: cc/
Following approval please return this affidavit to the Maricopa County School Superintendents Office.

N)-(11.0'64, Stop Payment
Arkf4.
Alitt
'PPsctio°
Business Resources Affidavit
vz--lonam MAMIE112
STATE OF ARIZONA A PRO V E-1-6
COUNTY OF MARICOPA
CLERK, BOARD
MARICOBA COUNTY /
Irma M. Ramirez
, being first duly sworn, upon oath deposes and states:
That on the / F day of , 20 , he/she presented to Littleton Elementary
School District No. 65, of Maricopa County, for payment, a claim for services rendered or supplies furnished during
the month of June , said claim being in the sum of Four Hundred Twenty Six Dollars&29/100
Dollars ($ 426.29 ) in payment of which Littleton Elementary School District No. 65 caused warrant/check
number 140102382 to be issued on 30 day of June , 20i
drawn on the warrant/check fund of Littleton Elementary School District No. 65 of Maricopa County, Arizona.
Affiant further states that although he/she was informed and believes that the above mentioned warrant/check
was regularly issued, the same has never been received, or has been lost.
Wherefore, affiant requests that the Governing Board order and the Littleton Elementary School District No. 65 issue
to him/her a replacement of said warrant/check number 140102382 in the sum of 426.29
Signature
Subscribed and sworn before me this "C.7773"-. /81-11 day of 'Fr:hot-4- nd_ 20
,
Signature of Notary Public
My Commission Expires
03/2013

STATE OF ARIZONA
COUNTY OF MARICOPA
LATORREY WHITEHEAD being duly sworn, upon oath deposes and says;
That on the 18TH day of FEBRUARY 2015 he/she presented to the
Treasurers of Maricopa County, for payment, a claim for services rendered or
supplies furnished during the month of FEBRUARY , said claim being in the sum of
FOUR HUNDRED THIRTY FIVE AND 00/100 dollars ($ 435.00 ) in payment of which the
Superintendent of Schools caused his/her Warrant Number 150054388 to be issued on
FEBRUARY 5TH , 2015 , drawn on the 781 Fund of Treasurers of
Maxicopa County, Arizona.
Claimant further says that although he/she was informed and believed that the above-
mentioned warrant was regularly issued, the same has never been received or has been lost.
Under penalty of perjury, claimant hereby affirms that this claim is correct and the amount
shown is due and owing.
Wherefore, claimant requests that the Board of Supervisors order and the Superintendent
of Schools issue him/her a duplicate of said Warrant Number 150054388 in the sum of
435.00
Claimant Signatur
Subscribed and sworn before me this I cit" day of N. HENRY siArlsoi 30 IC
My MARIO Comelisileri cowry Expires
414-1: November 5,2015
' Notary public
My commission expires time:1\1.6.1.c, 2.6 k
Following approval please return this affidavit to Maricopa County Education Service Agency.

rtilleicopai County
Hopmap Resnurces
Memo 03 0
-5 710 0
-TIC)
To: Fran McCarroll, Clerk of the Board 0 m X rl
0 73 <
From: Lisa Platek
Cr;
Date: March 4, 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 Lisa at ext. 63619 for any questions.
Please route approved Affidavits back to County Payroll, Suite
220.
Stale Dated Warrant Duplicate Warrant ,)
Thank you.

APPROVED
DATEt MAR)) 42015
AFFIDAVIT/NOTICE OF CLAIM RK, MARICOPA BOAR 0 COUNTY S
15 FEB 27 PH 1:36
STATE OF ARIZONA
FRJHA:: ESOURCES
COUNTY OF MARICOPA
H tUT) (JO BEING FIRST DULY SWORN
OATH, DEPOSES AND SAYS:
That on the 27 day of F-f2.(cl , 20 16 , he/she presented
to Maricopa County, for payment a claim for services rendered or supplies furnished during the
month of 2- 25- /5 , said claim being in the sum of
Dollars ($ 1 1 2 1 3 ,C)Ci ) in payment of which the Board of Supervisors caused the
Warrant No. CO22260'00 be issued on Q2- , 20 t , 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.(,(:)22.23[ In the sum of $ 213.0Q
Dated: 2 2 7- I 2O I C) Signed:
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 day of 'AU
'Mary Public
My commission expires: Turti),..--- ADRIAN L. MICELI
Notary Pe* - State of Athena
'I t d-0 I L( My MARICOPA commissaton COUNIY Expires
U ON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO: AprI14. 2016