STAMPED & REDACTED - FOR AGENDA ATTACHMENT - OMEX INTERNATIONAL.PDF
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INTEROFFICE MEMORANDUM TO: MARICOPA COUNTY CLERK OF THE BOARD FROM: MCSS FINANCE DESK (ANDIE DE LA ROSA) SUBJECT: AFFIDAVITS – REPLACEMENT OF LOST WARRANTS DATE: 01/11/2024 Please find attached 1 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 the MCSS Finance Desk at 602-372-4833 (Option 1) or via e-mail at FinanceDesk@maricopa.gov. Approved Affidavits may be routed back to the Superintendent of Schools - Finance Desk at 4041 N. Central Ave #1100. Thank you District Payee Warrant # Amount Liberty School Dist #25 Omex International 3700716206 $30,143.89 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. Ivan Royal/ OMEX International (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 11/29/2023 (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 b the sum of $_3_0_, 1_4_3_.8_ 9 _______ .(3) ¯ Signed: ___,,___°=-- --....,,___ ___________ (4) _7 (5) Subscribed and sworn to before me this ____ day of 0-n • l .O <t:1 .... ·· NOTARY P±BLIC (i) ANGELAHENRY My commission expires: Notary MARICOPA Public • Slae COUt.'TY d Arizona vsi2ew :!",e.., \ \ I I t> \ I / J-Oa · Expires Commlsalon November # 618838 01, 2025 (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 (if known) (6) 3700716206/25621300 Original Date of Issue (if known l (7) 11/29/23 Reason for original issue of Warrant/Check (8): □Payroll Iii For Services or Goods furnished Janitorial Services provided □other: Janitorial Services provided 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 1/11/24, 7:50 AM VMware Horizon https://horizon.maricopa.gov/portal/webclient/#/desktop 1/1