STAMPED & REDACTED - BRYCE DAVIS.PDF

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

Balsz Elementary #31 Bryce Davis 3700825381 $148.91

Date

Amount

Reissue WT #

\
MAR)COPA

COUNTY

Finance Desk
mm 20201016

Warrant Void/Stop Request

District Name / Number: Balsz Elementary School District #31 Attachments:

Contact Name: Marisol Bernal Martinez

Contact e-mail: Po Lost Warrant Affidavit (required for ALL reissues)

LJ Original Warrant

[] Vendor Letter (if requesting Vendor reissue)

Warrant Number Warrant Date | Amount Payee ice) ee)
(starting with “37") (mm/dd/yyyy) (as it appears in Check Manager) 2 & 3
3700825381 | 11/25/2024 $ 148.91 Bryce Davis ©O

Notes:

* check was lost.

Dict Appeared \; . = Dates \Q-@4— 959

For Internal Use Only
Clerk of Board Date:

Ss Report Date:

Schools Affidavit/Claim Form ate OPA

Application for a Duplicate Warrant/Check COUNTY
(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.
Bryce Davis (1), being first sworn, upon oath deposes and says:
Name/Claimant

On or about Ulas|2024 (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, gr 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. $_ 149.41 (3)
Signed: BL Zac B (4)
Print name: (required) bry (Od A Qa co!

(5) Subscribed and sworn to before me this 4 day of Avr 2025 _.
=i
Q2

NOTARY PUBLIC ‘AMANDA CARAVEG
g Notary Public - Arizona

— A Maricopa County
My commission expires: i Commission 4 65‘542

OMLL Od ACE}

(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) 3100925381
Original Date of Issue 10/17/25
one (tinown) @) 1/26 |2024 .
Reason for original issue of Warrant/Check (8):
O Payroll

O For Services or Goods furnished

M& Other: AP

S:\FinanceDesk\Schools-Warrants Checks notice of claim.docx
Revised May 2025 ARS. 11-632 & 15-999

Warrant (1 - mcto) - Warrant number: 3700825381, Stopped

4 i | =) \@| ¢)
Warrant Status Print | Attachments
Maintain New Status Setup Attachments
3700825381
4 Warrant header
General Posting
Warrant number: Invoice:
Holder: Invoice date:
Issued date: 11/25/2024 12:00:00 am Paid date:
Status: Stopped Positive pay sent date: 11/26/2024 09:00:15 am
colon flag:
yt "
ee — mene Agency voucher number: 2523
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
148.91. Bryce Davis es

Iq <4 m PL | 7 | ® | Identification of the warrant