STAMPED & REDACTED - ALEJANDRO ORTIZ.PDF
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v MAR)COPA COUNTY INTEROFFICE MEMORANDUM TO: MARICOPA COUNTY CLERK OF THE BOARD FROM: MCSS FINANCE DESK (MIKE MARTINEZ) SUBJECT: AFFIDAVITS - REPLACEMENT OF LOST WARRANTS DATE: 10/17/2025 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 WestMEC #402 Alejandro Ortiz 3700908144 $3,606.00 Date: Amount: Reissue WT # l : : M A R) Cc '@) PA District #: COUNTY District Name: West-MEC Contact Name: Sara Hartley Contact Email: ae RANT VOID/STOP REQUEST Warrant # 3700908144 Warrant Date 99/24/2025 Warrant Amount $ 3,606.00 Payee alejandro Ortiz Choose one option: O Void Warrant Warrant is in possession of the district and will be sent back to MCSS Finance Desk with the next available 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: Lost District Approver: tjedieM onbeneg re Date: /O-/6 -XS 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. Alejandro Ortiz (1), being first sworn, upon oath deposes and says: ““Name/Claimant On or about September 24, 2025 (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 $. 3,606.00 (3) Signed: Ay (4) (5) Subscribed and sworn to before me this _/Q day of CCtobey, 20 45 Cin b Fox a/ ea PUBLIC CD My commission expires: O91 02/DO2X¥ TAYLOR A. FEIGAL Notary Public - State of Arizona MARICOPA COUNTY Commission # 669424 ___Expires June 2,25 _| Note: Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. Ww t/Check Numbe arrant/Check Number 3700908144 / 402561436 Original Date of Issue 9/24/2025 (if known) (7) Reason for original issue of Warrant/Check (8): ; 10/17/25 O Payroll ~ Cl For Services or Goods furnished Student Refund ™ Other: Student Refund 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 Warrant (1 - mcto) - Warrant number: 3700908144, Stopped Warrant - = yy wi S Warrant Status Print Attachments ad Maintain New Status Setup Attachments 3700908144 4 Warrant header Warrant number: 3 1 Invoice: Holder: Invoice date: Issued date: 9/24/2025 12:00:00 am Paid date: Status: Stopped Positive pay sent date: 9/25/2025 09:31:27 am Exception flag: =: = 9: t son: ioctl _ mene Agency voucher number: 1027 Queued for positive pay: Agency claim number: : Agency low orig: Locked for reconcile: Agency PO number: Registered Agency sub fund: Date registered: Agency dept num: No of days interest: 0 Annual interest rate: 0.00000 4 Warrant Lines oO Amount Payee Account 3,606.00 Alejandro Ortiz PC Iq <4 m PL | 7 | ® | Identification of the warrant