STAMPED & REDACTED - KEVIN MCCORMICK.PDF

Office of the Maricopa County
School Superintendent

Steve Watson

INTEROFFICE MEMORANDUM

TO: MARICOPA COUNTY CLERK OF THE BOARD
FROM: MCSS FINANCE DESK (ANDIE DE LA ROSA)
SUBJECT: AFFIDAVITS -REPLACEMENT OF LOST WARRANTS

DATE: 01/09/2025

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

Queen Creek Dist #95 McCormick, Kevin 3700832664 $449.63

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Schools Affidavit/Claim Form

Application for a Duplicate Warrant/ Check (detinitions 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.

MCCORMICK, KEVIN PAUL (1), being first sworn, upon oath deposes and says:

Name/Clataant

On or about (2. \a4 aoa (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

sarees pei to him/her in the sum of $449.63 (3)
= (4)

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Signed: __|

(5) Subscribed and sworn to before me this Oday of TONue-r 4 200,

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NOTARY PUBLIC

CASSANDRA KENNEDY
Notary Pudlia - State of Arizona
PINAL COUNTY
Commission # 620036

My co sion, xpin s:
heJ0 BL: 2 (seal)

Explras May %, 2026

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
arrant/Check number 13700832664

Original Pate of issue /42/24/2024

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

O For Services or Goods furnished
C) Other:

S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schoo 1/10/25
Revised June 2015 : - 11-632 & 15-999

1/9/25, 10:02 AM

Ji Warrant (1 - mcto) - Warrant number: 371 |, Stoppe:
i] wi 1 ) - Wi ber: 3700832664, Stopped

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yh Warrant | Status | Print
Maintain New Status | Sctup | Attachments
3700832664
4 Warrant header ~ /
General Posting
Warrant number 3709832664) Invoice:
Holder: Invoice date:
issued date: 12/24/2024 12:00:00 am Paid date:
Status; Stopped Positive pay sent date: 12/20/2024 09:00:11 am
Exception flag: li Agency details
Exception reason: None

Queued for positive pay: |.77

Lockedforreconcile: |_|

Agency voucher number 15
Agency clain nurober:
Agency tow orig:

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
ta Amount | Payee : Account ;

449.63 MCCORMICK, KEVIN PAUL

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