STAMPED & REDACTED-THOMAS PACE-3700807852.PDF
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MAR) COPA
COUNTY
INTEROFFICE MEMORANDUM
TO: MARICOPA COUNTY CLERK OF THE BOARD
FROM: MCSS FINANCE DESK (CHRISTY ADAMS)
SUBJECT: AFFIDAVITS —-REPLACEMENT OF LOST WARRANTS
DATE: 08/04/2025
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
QC USD #95 PACE, THOMAS 3700807852 $610.80
Date
Amount
Reissue WT #
Office of the Maricopa County
School Superintendent
District Name / Number: Queen Creek Unified School District Attachments:
Contact Name: Kathy Saxton
Contact 0 lv] Lost Warrant Affidavit (required for ALL reissues)
Finance Desk
mm 20201016
Warrant Void/Stop Request
Original Warrant
Vendor Letter (if requesting Vendor reissue)
Warrant Number
{starting with “37"}
Warrant Date
(mm/dd/yyyy)
Amount Payee
{as it appears in Check Manager)
3700807852
10/1/2024
$ 610.80 PACE, THOMAS
Notes: Lost checks (3) in total.
District Approver:
For Internal Use Only
Clerk of Board Date:
Void Report Date:
rus
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.
PACE, THOMAS (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about \o o\ | Aad (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 361 0.80 (3)
signed Jere (4)
(5) masspayen sre to before methis__|___day of Ayes? 20225"
NOTARY PUBLIC
CASSANDRA KENNEDY
Notary Public - State of Arizona
PINAL GOUNTY
Commission # 629036
Exphos May 8, 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 Numb
arranticheck Number 13700807852
mereitinam cy |10/01/202 4
Reason for original issue of Warrant/Check (8):
Payroll
) For Services or Goods furnished -
( Other:
8/4/25
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of clalm.doc
Revised June 2015 ARS. 11-632 & 15-999
BA ui
cosoft Dynamics AX ~ Maricopa Assaciation of Governments, AZ [TRSPVDAXAOSO3: Session ID - 202] - {1 - rctol
,
Warrant (1 - ncto) - Warrant number: 3700807852, Stopped
| Warrant |
Kbit) 1s iy O34
ae, |
baht Warrant | Status Print | Attachments
Warra Y | |
N Maintain New | Status | Setup | Attachments |
je
3700807852
4 Fa
en Warrant header
General Posting
2 Ac Warrant number: 97008078521 Invoice:
4 Holder: Invoice date:
4 Issued date: 10/1/2024 12:00:00 am Paid date:
1 Status; Stopped Positive pay sent date: 9/27/2024 09:00:06 am
beception flag: It Agency detalls
ception eases None Agency voucher number: 9
Queued for positive pay: |} Agency claim numben
Agency low orig:
Locked forreconcite: | | Agency PO number
Registered Agency sub fund:
Date registered: Agency dept num:
No of days interest: Q
Annual interest rate: 0,00000
« Warrant Lines
[2 Amount : Payee
610.80 PACE, THOMAS
beg ed ote Bt | | 21 | Identification of the warrant