STAMPED & REDACTED- WICKENBURG USD FICA -3700884720.PDF

v
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: 08/05/2025

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
Wickenburg USD #009 Wickenburg USD FICA 3700884720 | $9,546.10

Date

Amount

Reissue WT #

Office of the Maricopa County Finance Desk

School Superintendent mmm 20201016

Warrant Void/Stop Request

District Name / Number: WICKENBURG UNIFIED Ga DIS, Attachments:
Contact Name: LISA SMITH 4 [| Original Warrant

Contact e-mail: Po Kf Lost Warrant Affidavit (required for ALL reissues)

[| Vendor Letter {if requesting Vendor reissue)

Warrant Number Warrant Date | Amount Payee cs 2 @
(starting with “37") imm/dd/yyyy) {as it appears In Check Manager) brat 2 2
> G #

Co)

fad

3700884720} 7/10/25 |$9,546.10 WICKENBURG USD FICA OoOmM

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Date: aelas

District Approver:

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

Schools Affidavit/Claim Form MA RI COPA
Application for a Duplicate Warrant/Check COUNTY

(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.

Wickenburg USD FICA (1), being first sworn, upon oath deposes and says:
Name/Claimant

On or about 97/10/2025 (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 § 9,546.1 0 . (3)
Signed: Le owe LCM g——~ (4)

Print name: (required) Denine Wong

‘Vb. cribed and sworn to before me this wrest LE of 7 YAS 2029

NOTARY 1 tN FI

ENISE A BERGMAN
NOTARY PUBLIC - ARIZONA,
Ission expires COMMBSION # Buses
m ss : MY COMMISSION EXPIRES
Werpor") i (cel)

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 Number
(if known) (6) 3700884720
Original Pate oF issue 07/10/2025 8/7/25
Reason for original issue of Warrant/Check (8):
{1 Payroll
4 For Services or Goods furnished
fm Other: For Wickenburg USD FICA

$:\FinanceDesk\Schools-Warrants Checks notice of claim.docx
Revised May 2025 ARS. 11-632 & 15-999

Wickenburg Unified School District

101 Coconino St, Wickenburg, AZ
Phone: 928-668-5350
wickenburgschools.org

Aug. Sth, 2025

To Whom It May Concern,

Please reissue the following warrants, which were all issued on July 10fh, 2025. These
warrants were lost by Chase Bank and were not deposited into the account they were
payable to.

Warrant: 3700884719, $3,961.49 payable to Wickenburg USD Federal W H Tax
Warrant: 3700884720, $9,546.10 payable to Wickenburg USD FICA
Warrant: 3700884721, $1,401.40 payable to WUSD State Tax Withholding

We certify the signer on the notarized affidavit, Denine Wong, is an authorized
representative of WUSD and may communicate on behalf of our company.

JAMES SCOTT

Director of Business Services
Wickenburg Unified Schoo! District

Every child has hope, every student Is a graduate, every graduate has a dream.

Warrant (1 - meto) - Warrant number: 3700824720, Stopped

| Warrant |

palit Warrant | Status

Print | Attachments

*
Maintain New Status | Setup | Attachments
| 3700884720
4 Warrant header — Oo

General Posting

Warrant number: Invoice:

Holder: Inveice date:

issued date: 7/10/2025 12:00:00 am Paid date:

Status: Stopped Positive pay sent date: 7/10/2025 09:31:01 am

tio! f

Exception flag Vy Agency details

Exception reason: Wane

Agency voucher number 1001
Queued for positive pay: [| Agency claim number:
Agency law orig:

Locked for reconcile. | | 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

[1 Amount | Payee Account