STAMPED & REDACTED-THOMAS PACE-3700812259.PDF

v
MARICOPA

COUNTY

INTEROFFICE MEMORANDUM

TO:
FROM:
SUBJECT:

DATE:

MARICOPA COUNTY CLERK OF THE BOARD
MCSS FINANCE DESK (CHRISTY ADAMS)
AFFIDAVITS — REPLACEMENT OF LOST WARRANTS

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 Watrant # | Amount
Qc USD #95 PACE, THOMAS 3700812259 $487.37

Date

Amount

Reissue WT #

Office of the Maricopa County . Finance Desk

School Superintendent

Warrant Void/Stop Request

District Name / Number: Queen Creek Unified School District Attachments:

Contact Name: Kathy Saxton Original Warrant

Contact onc lv] Lost Warrant Affidavit (required for ALL reissues}

Vendor Letter {if requesting Vendor reissue}

Warrant Number © | Warrant Date | Amount -Payee zs 2 o

{starting with “377} + {mm/dd/yyyy) : (as it appears in Check Manager) 2 FS 2
fl & -

oe

3700812259| 10/15/2024 | $ 487.37 PACE, THOMAS ©OwW

Notes: Lost checks (3) in total.

District Approver:

For Internal Use Only
Clerk of Board Date: Void Report Date:

Schools Affidavit/Claim Form

Application fora 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:
On or about \0} \G laogu (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 $487.37 (3)

Signed: “/ or (4)

65) or and sworn to before me this___| __day of Pyqust 20.2%.

NOTARY PUBLIC

CASSANDRA KENNEDY

ji rac: Notary Publis - Stata of Ar
My commission expires ree lal ton
OS UE ip Commission # 629036
' Explies May B, 2026 (seal)

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 Numb
arrant/Check Number 13790812259

Original Date of o* 10/15/2024

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

{) For Services or Goods furnished
O Other:

8/4/25

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

Microsoft Dynamics AX - Maricopa Association of Governments, AZ [TRSEYDAXAOSO3
@ Warrant (1 - meto) - Warrant numben 3700812259, Stopped

sion ID - 202] - [1 - mctol

| Warrant |

a Warrant | Status | Print | Attachments
Warra vi
N Maintain New | Status | Setup | Attachments
le so
3700812259
4 Fa
b a Warrant header
General Posting
4 Ac) Warrant number 3700812259 Invoice:
4 Holder: Invoice date:
4 Issued date: 10/15/2024 = 12:00:00 am Paid date:
: Status: Stopped Positive pay sent date: 10/11/2024 (09:00:36 am
“| Exception flag: i Agency details
Exception reason: None

. Agency voucher number: 10
Queued for positive pay: {| Agency claim number:
Agency low orig:
Locked forreconcile: ||

Agency PO number:
Registered Agency sub fund:
Date registered: Agency dept num:
No of days interest: Qo
Annual interest rate: 0,00000
4 Warrant Lines
(1 Amount Payee Account

meee Pe

iq <@ of b& bl | oe | 9 | Identification of the warrant