STAMPED AND REDACTED 3700916075 - MICHAEL VALDEZ.PDF

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MARICOPA
COUNTY

INTEROFFICE MEMORANDUM

TO: MARICOPA COUNTY CLERK OF THE BOARD

FROM: MCSS FINANCE DESK (JENIFER PEASE)

SUBJECT: AFFIDAVITS ~ REPLACEMENT OF LOST WARRANTS °

DATE: 12/16/2025

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

Saddle Mountain USD #90

Valdez, Michael

3700916075

$338.06

Date:

Amount:

Reissue WT #

MA RC OPA District # GO
COUNTY

District Name: SMUSD #90

Contact Name: Crystal Mondragon
Contact Email:

WARRANT VOID/STOP REQUEST
Warrant # 3700916075

Warrant Date 19/22/2025 Warrant Amount $ 338.06

Payee yal DEZ, MICHAEL

Choose one option:

‘@) Void Warrant

Warrant is in possession of the district and will be sent back to MCSS Finance Desk with the next
avaijable courier run.

@) Stop Warrant
Warrant has been lost or destroyed and is not in possession of the district.

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:

Notes: Check was stolen from emlpoyees car.

District Approver: Ci th~ — Date: 49/44/2025

Revised 10/8/2025

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 is page 2 of this form.

VALDEZ, MICHAEL ; :
RESET (1), being first sworn, upon oath deposes and says:

On or about tober 22, 707. (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 $338. 6 (3)
7 fo
Signed: <2" aa LO 2 % 4 (4)

#

7
(5) Subscriped and or me this 6/47 day of _ Pecerrer 2025.

NOTARY PUBLIQ-—4——_f
yi commission expires:

JORGE GARCIA
NOTARY PUBLIC - ARIZONA
Maricopa County

Commission # 673439
My Comm. Exp. Aug, 28, 2028

(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 "13700916075

12/17/25

Original Date of Issue 14 0/22/2025

Reason for original issue of Warrant/Check (8):
0 Payroll

is} For Services or Goods furnished REIMBURSEMENT
OC Other; REIMBURSEMENT

S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc
Revised June 2015 AR.S. 11-632 & 15-999

APPROVED

Change Warrant Status By Grace.Ramirez at 10:27 am, Nov 19, 2025

Requested by: Mike Martine

Agency/ District MSS \ Saddie Mouatala

CHANGE WARRANT STATUS

Stop { x (Warrant has been Issued and released)

Void I ~_] (Warrant has been Issued but het by district}

Delete [ETT] system error and warrant number will be reused)

Warrant Number (3700926075

Arnaount s3a0s 7j

Payee

If the information does net match, the change will not take place

Once the change has been processed, reversal is net an oplian

Please send the completed form to the following ¢- mall account for processing: