STAMPED & REDACTED-KATELYN TELLEZ -3700857301.PDF

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MARICOPA
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
EVIT #401 TELLEZ, KATELYN 3700857301 $175.00

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Schools Affidavit/Clatin Form

Application for a Duplicate Warrant/ Check (detnitions ara on page 2)

STATI OF ARIZONA Nola: Nunibura on thls form corranpond Wy numbers on tho
COUNTY OF MARICOPA Instuctlon ahoat which is page 2 of this form.

mai leh dh Ville. ll) balng first sworn, upon oath deposes and says:
On or about "4 i? LLP) (dite)(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 fost or destroyed and there Is
ho teasonable probabliity 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, clalmant hereby affirms that this claim {s correct
and the amount shown js due and owing, and the applicant requests that a replacement

warrant/check be issued to, him/her in the sum of $175.00 (3)
Signed: Lilla Ar, (4)

Laan
(5) wasn sworn to before me this. 04 day of August 20.25",
NOTARY PUBLIC » RICHARD SAMUEL
\ Notary Pubile » Slate of Arizona
E MARICOPA COUNTY

Coramission # 684412
Explros Maret 13, 2029

Ni commission expires:
Maed 13, 074

(seal)

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

Warrant/Check Number }3799857301 (KATELYN TELLEZ 401664891)

(iL known) (6)

Original Date of Issue
Ut known) (7) 3/27/25 8/5/25 _

Reason for orlginal Issue of Warrant/Chack (8):
C1 Payroll
(1 For Services or Goods furnished EMPLOYEE REUMBRSEMENT

@ Other: EMPLOYEE REUMBRSEMENT

SAPROCESSES\Warranty » Duplicate ar Slate\02 Formis\Schools\Schaals- Warrants Checks notica of claimatoc
Revised June 2045

AGUS. 11-652 & 15-999

See 2 TH DUG MER TOON SAINE ACIAU WAT EN SADR HOON DLICHTT OVIEW |

SCHOOL EXPENSE WARRANT: . -  4£4@z 700857301

TREASURER OF MARICOPA COUNTY

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orerigat — 5

nang kg seg ms Sep ee

: 03/27/2025 4016648941 3

: East Valley Institute of Technology District #404 °
: PAY WARRANT AMOUNT fi
: “Ono Hundred Seventy Five and 00/100 Dollars $176.00 3
; VOID AFTER 865 DAYS E
‘TO TELLEZ, KATELYN : :
“ORD os halla 4d, j
{OF Ge _ Superintendent of she Fuzen sianatunes —&

MARICOPA COUNTY SCHOOLS » PHOENIX, ARIZONA 03/27/2025 Check: 401664891 EXPENSE

HARLAND CLARKE HQz892 40038916.

AP 20250328 3700857301
TELLEZ, KATELYN { | osre7e026 |
Payee | [Check Date | _
Account Number PO Number Inyolce Amount
| Hoe HOSA CONFER 175 00 i
i
i
1
ho
i i
VOUCHER; — 1040 TOTAL: $176.00 | :
i

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3 Warrant (1 - meto) - Warrant number: 3700857301, Stopped

bei Warrant | Status | Print | Attachments
Warra 7
N Maintain New | Status | Setup | Attachments
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| 3700857301
4 Fay
rn 4 Warrant header
General Posting
4 he Warrant number: Invoice:
Z Holder: Invoice date:
4 Issued date: 3/27/2025 12:00:00 am Paid date:
4 Status: Stopped Positive pay sent date: 3/28/2025 12:00:02 pm
a Exception flag:
| weep fen ag I Agency details
Exception reason: Nene Agency voucher number: 1040
Queued for positive pay: || Agency claim number:
Agency low orig:
Locked forreconcile: = | i 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 . —_ ~
[Amount . Payee Account

175.00 TELLEZ, KATELYN