STAMPED & REDACTED-THOMAS PACE-3700820283.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 _ Warrant # Amount
QC USD #95 PACE, THOMAS 3700820283 $610.79

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 ono | Lost Warrant Affidavit (required for ALL reissues)

Vendor Letter (if requesting Vendor reissue)

Warrant Number Warrant Date | Amount -Payee s 2 «@
(starting with "37"} (mm/dd/yy) (as it cppears in Check Manager) sd ro) £ 2
a

- - - @©ou
3700820283) 11/12/2024 |$ 610.79 PACE, THOMAS @Qowv

Notes: | ost checks (3) in total.
| ON \s
Date: va) [ | Tey

Clerk of Board Date: Void Report Date:

District Approver:

For Internal Use Only

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:
Name/Clalmant

On or about __\\} yalacaty (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 g 61 0.79 3)

an

Signed: i er | (4)

(5) ey d and sworn to before me this __[ day of preys 20625.

NOTARY PUBLIC

CASSANDRA KENNEDY
Notary Pubtls - ar of Adzena
My abide expires: gunsson 1b
(p ne (seal)

Note; Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued,

Wi t/Check Numb
aan chy (6) *" 13700820283

Original Date of Issue 11/1 2/202 4

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

fl Payroll 8/4/25

CO For Services or Goods furnished
C) Other:

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

rosoft Dynamics AX - Maricopa Association of Governments, AZ [TRSPVDAXAOSD2: Session ID - 202) - [1 mcto].

Mi
@

Warrant (1 - mcto) - Warrant number: 3700820283, Stopped

| Warrant |

a) s
a) 8)
icht Warrant | Status | Print | Attachments
Warra v
Ne Maintain New | Status | Setup | Attachments
3700820283
a Fa
ey? Warrant header
Generat Posting
aac Warrant number laveice:
4 Holder: Invoice date:
a Issued date: 41/12/2024 = 12:00:00 am Paid date:
Status: Stopped Positive pay sent dates 11/8/2024 09:00:10 am
om Exception flag: Ld Agency details
Exception reason: None Agency voucher number: 12
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: 0
Annual interest rate: 0,00000
a Warrant Lines
DD Amount Payee Account

610.79 PACE, THOMAS

Id qin eB PB | eo | id] | Identification of the warrant