STAMPED & REDACTED-DULCE TERRAZAS.PDF

v
MARICOPA
COUNTY

INTEROFFICE MEMORANDUM

TO: MARICOPA COUNTY CLERK OF THE BOARD

FROM: MCSS FINANCE DESK (CHRISTY ADAMS)

SUBJECT: AFFIDAVITS —-REPLACEMENT OF LOST WARRANTS

DATE: 07/22/2025

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 Elm SD #31 Dulce Terrazas 3700783488 $353.40

Finance Desk
mum 20201016

v
MAR)COPA

Date

Amount

Relssue WT #

COUNTY

Wartant Void/Stop Request

District Name / Number: Balsz Elementary School District #31

Contact Name: Marisol Bernal Martinez

ONS

Attachments:

[| Original Warrant

[v] Lost Warrant Affidavit (required for ALL reissues}

C] Vendor Letter (if requesting Vendor reissue}

Warrant Number Werrant Date | Amount Payee 7% a2 ©

{starting with “37") {mm/dd/yyyy) las it appears In Check Manager} 2 2 3
3700783488) 7/24/2024 | $ 353.40 Dulce Terrazas ©OoOwW

Not > a
ofes: Check was lost yey VAS

ak Ww
aA
District Approver: ore Date: TAS AG BOSS
SS

For Internal Use Only

Clerk of Board Date:

Void Report Date:

Schools Affidavit/Claim Form MARICOPA

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.

Dulee. (ENO20S (1), being first sworn, upon oath deposes and says:
Name/Clalmant

On or about or faa [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, 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 fs due and owing, and the applicant requests that a replacement

warrant/check be issued to him/her in the sum of $ 25>. WO . (3)
Signed: — (4)

Print name: (required) < \_da\ Ce Vie htres

(5) Subscribed and sworn to before me this \ day of JW) 22

—

AMANDA EO
Notary Public - Arizona
Maricopa County
Commission # 651542
My Comm, Expires Jun 20, 2027

NOTARY PUBLIC

My commission expires:
Cen. AS), Hewl

(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) 31 007338483
Original Date of Issue .
(if known) (7) OT - 2472024
Reason for original issue of Warrant/Check (8): 7/24/25
0 Payroll [

i For Services or Goods furnished.
YX Other: AY

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

4 Warrant (1 - micto) - Warrant number: 3700783488, Stopped

| Warrant |

Ban Warrant | Status

Print | Attachments

Queued for positive pay: |’!

Agency voucher number: 2500
Agency claim number:

353.40 Dulce Terrazas

. 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
1 Amount Payee Account

i
~~ |
Maintain New Status Setup | Attachments
| 3700783488
4 Warrant header :
General Posting
Warrant number: 3700783488) Invoice:
Holder: Invoice date:
Issued date: 1624/2024 12:00:00 am Paid date:
Status: Stopped Positive pay sent date: 7/24/2024 09:00:05 am
Exception flag: in Agency details
| Exception reason: None