STAMPED & REDACTED CLARISSA FLORES.PDF

INTEROFFICE MEMORANDUM
Maricopa County Schools Superintendent Office
TO: CLERK OF THE BOARD
FROM: Terri Ysaguirre
SUBJECT: Affidavits - Replacement of Lost Warrants
DATE: 4/22/2021
Please find attached 1 Affidavit/Notice of Claim(s) for lost warrants for inclusion on the next
available Board agenda
Vv The attached item(s) have been researched to ensure that the warrant(s) in question have
not been cashed or previously re-issued.
Vv ~ The original warrant(s) have had a stop payment done.
If you have any questions, please contact Terri Ysaguirre at 602-372-1245 or via e-mail at
terri.ysaguirre@maricopa.gov. Approved Affidavits may be routed back to the Superintendent
of School Finance Division at 4041 N. Central Avenue #1200, (12th Floor)
Thank you.
#65 Littleton Elementary Clarissa Flores $1,878.85
2 ran
RECEIVED
APR 28 202!
MARICOPS COUNTY
CLERK BOARD OF SUPERVISORS

Application for a Duplicate or Stale-Dated Warrant/ Check
Affidavit/Claim Form
This application is for: [] Duplicate or L] Stale-Dated
(definitions are on page 2)
STATE OF ARIZONA Note: Numbers on this form correspond to numbers the
COUNTY OF MARICOPA Instruction sheet which is page 2 of this form. on
+
rissa “file € $ (1), being first
ame/Claiman sworn, upon oath deposes and says:
On or about o/ uly ZF 2020
(date)(2) a warrant/check was issued to the
above named person/ehtity in the amount as stated below. Such
either never received or was warrant/check 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
and the amount shown is due and owing, and the correct
applicant requests that a replacement
warrant/check be issued to him/her in the sum of $ /, ILA f Sf
(3)
Signed: Chaseiaer fle
hsa—
(4)
Note, Please attach a copy of the warrant/check if available
evidence that and/or any other
a warrant/check was originally issued,
~
(8) Subscribed and sworn to before me this_| (0 _day of Anica |
nf §)
NOTARY PUBLIC
ELYSE OROZCO
5	1	42	1	5	2	567	1987	207	83	87.729263	commissio
5	1	42	1	5	3	816	1984	165	56	96.816086	expires:
5	1	42	1	5	4	1525	2001	156	78	88.717331	MARICOPA
5	1	42	1	5	5	1694	2001	117	78	93.726524	COUNTY
4	1	42	1	6	0	575	2023	1637	100	-1	
5	1	42	1	6	1	575	2023	235	59	0.000000	‘Dis
5	1	42	1	6	2	1456	2059	157	11	0.000000	xpos ——- P a, Notery Pubic - Stet of Arizona
March 03, 2028 (seal)
Warrant/Check Number
(if known) (6) 7 700 338053
Original Date of Issue
(if known) (7) ZR te (oo-n@®)
Reason for original issue of Warrant/Check (8):
BP
QO For Services or Goods furnished 26/2021
j 04s
CO) Treasurer's refund/payment
O Other:
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc
Revised April 2015
ARS, 11-632 & 11-644

MARICOPA COUNTY SCHOOL
4041 N Céritral, Sulte 1400 SUPERINTENDENT
| PHOENIX, AZ 86072 |
TO: PAYROLL = ACCOUNTS PAYABLE
PLEASE STOP PAYMENT AND REISSUE THE
FOLLOWING WARRANT:
DISTRICT NUMBER: (5S
PERSON REQUESTING —
STOP PAYMENT: SH Miro ,
van PHONE #:
_— EXT:.
WARRANT NUMBER: 37
. 20355053 WARRANTDATE:
: (prefix) ~ [QE] 20.90
(number)
(mm) (dd) “(yy)
PAYABLE TO: arissa—FYones
AMOUNT:
LEGS:
FUND NO:
CO (
VOUCHER NO:
CHECK ONE: EXPENSE
PAYROLL
LJ [7]
REASON FOR SToP:
Jets ./
(LOST, DESTROYED, ETC.)
ONE ORIGINAL AFFIDAVIT AND ONE COPY OF THE
ISSUE A REPLACEME NT WARRANT, AFFIDAVIT ARE ATTACHED, PLEASE
(FOR COUNTY USE ONLY)
STATUS VERIFIED: lsu
STOP DATE:
STOP VERIFIED: REPLACED:
AFFIDAVIT SENT: WARRANT #:
AFFIDAVIT APPROVED:
RECONS RETURNED: STOP PREPAID
\WMoss_411\data\ReposttoryShare\PayRolNFront Desk (finance) sample memos, etel.OST WARRANT Rovieod 4/8/07
STOP-RE8gyE COVER SHEET. doe

Office of the Maricopa County
School Superintendent
Watrant Void/Stop Request
Attachments:
District a Name / Number: Py (2) 244 OSsedkes., Elo S\evrern ue yp Sxlaco \
mv mofo [|
as Original Warrant
Contact Name: €. 5 1 lay Arey Ye 1 fe H .) i
uy
[ | Infinite Visions Void Report
Contact e-mail: ”
Ne Lost Warrant Affidavit (if requesting reissue)
on!
“~~
Vendor Letter (if requesting reissue for a company)
a)
3700338052 | 7 heb. | / B79 FS / / “~)
_/G@rrsse ~tvores
A
Check here if requesting MCSS reissue the warrant |
ie Ae
Notes: .
PS gym y ?
District AN f
Approver: “S/o? Date: | twid
ms <= Qa]
¢ v

ft Excel
Warrant number
& Status Warrant number issued date Paid date Amount
Stopped 3700338052 28/2020 12:00:00 am 1,878.85
Warrant number: ata ns3
Amount Payee 4ccount
{LB7S.85 he WOR FLORES, CLARISSA E