STAMPED & REDACTED-CAROLINE KLUGE.PDF

v
MARICOPA
COUNTY

INTEROFFICE MEMORANDUM

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

DATE: 08/07/2025

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 USD #95 KLUGE, CAROLINE 3700887044 $425.31

Office of the Maricopa County Finance Desk

Date

Amount

Relssue WT #

School Superintendent nm 20201016

Warrant Void/Stop Request

District Name / Number: Queen Creek Unified School District

Contact Name: Kathy Saxton

Attachments:

[| Original Warrant
lv] Lost Warrant Affidavit (required for ALL reissues}

[] Vendor Letter (if requesting Vendor reissue}

Warrant Number Warrant Date
(starting with “37") {mm/dd/yyyy)

Amount

Payee

{os it appears in Check Manager}

Void
Stop
e-issue

3700887044, 7/22/2025

$ 425.31

KLUGE, CAROLINE ‘OR@I

©OU

@©@O

@®@OU

Notes: | ost check in mail

District Approver:

Date: 3| € [as

For Internal Use Only
Clerk of Board Date:

Void Report Date:

Schools Affidavit/Claim Form

Application for a 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.
KLUGE, CAROLINE (1), being first sworn, upon oath deposes and says:

Name/Clatmant

On or about o1\a3.\ 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

warrant/check be issued to him/her in the sum of 425.31 «3)

Signed: sda Lp ef (4)

(5) Subscribed oe to before me this_ 5 day of fruqost 20.23,

l

NOTARY-PUBLIC

a siaeor

CASSANDRA KENNEDY
Notary Public - State of Arizona
PINAL COUNTY
Commission # 629036
Expies May 8, 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.

Warrant/Check Numb
arrant/ehek mumber 13700887044

Original Date of Issue 07/22/2025

Reason for original issue of Warrant/Check (8):
Payroll
8/8/25
O For Services or Goods furnished -

CO Other:

$:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schoois\Schools-Warrants Checks notice of clalm.doc
Revised June 2015 ARS, 11-632 & 15-999

8/6/25, 2:05 PM VMware Horizon

Warrant (1 - mcto) - Warrant number: 3700887044, Stopped

Warrant |

i =| ae L
pehi Warrant | Status | Print | Attachments
v
Maintain New Status | Setup | Attachments
3700887044
4 Warrant header
General Posting
Warrant number: Invoice:
Holder: Invoice date:
Issued date: 1/22/2025 12:00:00 am Paid date:
Status: Stopped Positive pay sent date: 7/18/2025 09:30:37 am
Exception flag: i Agency details
Exception reason: None Agency voucher number:
Queued for positive pay:!-1 Agency claim number:
Agency tow arig: Is
; Agency PO number:
: i
Locked for reconcile: i Agency sub fund:
Registered Agency dept num:
Date registered:
No of days interest: 0
Annual interest rate: 0.0001
4 Warrant Lines
CL] Amount ; Payee Account
lq ad ge em pl | a | 15; | Identification of the warrant

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