STAMPED AND REDACTED 3700834580 - CASEY GIPE.PDF
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MARICOPA
COUNTY
INTEROFFICE MEMORANDUM
TO:
FROM:
SUBJECT:
DATE:
MARICOPA COUNTY CLERK OF THE BOARD
MCSS FINANCE DESK (JENIFER PEASE)
AFFIDAVITS - REPLACEMENT OF LOST WARRANTS
12/5/2025
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 |
Wickenburg Unified Gipe, Casey
3700834580
$77.29
Date:
Amount:
Reissue WT #
b : z
MA R) Cc fe) PA District #+:
ae Void pate\'2|5|2S WP?
District Name: WICKENBURG UNIFIED SCHOOL DISTRICT #9 BOS Date:
Contact Name: LISA SMITH
Warrant # 3700834580
WARRANT VOID REQUEST
Warrant Date 4/7/2025 Warrant Amount ¢ 77 99
Payee GIPE, CASEY
Void Warrant
If the warrant is in possession of the district please destroy or return to the MCSS Finance desk with
your next availabie courier run.
If requesting MCSS to reissue this warrant select the Reissue Warrant box below and submit a
notarized affidavit along with a vendor letter (if payee is not an individual).
Reissue Warrant: FA
Notes: LOST CHECK, PLEASE REISSUE
District Approver: +: (7/7. Date: 42/4/95)
Revised 11/21/2025
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 ts page 2 of this form.
Gipe, Casey (1), being first sworn, upon oath deposes and says:
—Name/Clalment
On or about 11712025 (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 bi
of $77.29 (3)
D) (4)
Signed:
(5) “Les, and sworn to ne this Bia day of J ¥ Cor DY 2025.
NOFARY PUBLIC
BERGMAN
DENISER! IC + ARIZONA
(seal)
My commission expires: WAANIOOPA COUNTY
A1R205 =] 27 Ven2 72 SO eines
, ‘MARCH 27, 2027
en
Note. Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
Wi Check Numbe
prranty heck pri " 13700834580 / 9625223
Original Date of Issue
riainal Date of is 01/07/2025 ey
Reason for original issue of Warrant/Check (8):
1 Payroll
Cl For Services or Goods furnished Mileage reimbursement
f Other: Mileage reimbursement
‘S:\PROCESSES\Wartrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc
Revised June 2015 A.R.S, 11-632 & 15-999
12/5/25, 9:33 AM Maricopa County - Treasurer's Cffice - Agency Web
(| Jenifer {ij BUCKEYE
Poase "USD
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Jnquir . . :
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WARRANT DETAILS FOR
WICKENBURG USD
WARRANT PREEDE 370
Warrant Number coer om AMOUNT
| 3700834580 $77.29
Issue Date
1/7/2025 ie}
The object code will be 4100.
Status -- Payee Name
L Void GIPE, CASEY
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https://treasurer.maricopa.gov/AgencyWeb/WarrantMainlenance/Warrants/ 1991203
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