STAMPED & REDACTED - MISTY MOORE.PDF

Maricopa County — Formal (2025-06-11)

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MAR)COPA

INTEROFFICE MEMORANDUM
TO: MARICOPA COUNTY CLERK OF THE BOARD
FROM: MCSS FINANCE DESK (ANDIE DE LA ROSA)

SUBJECT: AFFIDAVITS -REPLACEMENT OF LOST WARRANTS

DATE: 05/15/2025

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

Buckeye Union Dist #201 | Moore, Misty 3700765762 $391.12

Date

Amount

Reissue WT #

Office of the Maricopa County Finance Desk

School Superintendent mm 20201016

Warrant Void/Stop Request

District Name / Number: Buckeye Union High School Dist. #201

Attachments:
Contact Name: Laura Blake [] Original Warrant

Contact e-mail: Po [xx] Lost Warrant Affidavit (required for ALL reissues)

xx] Vendor Letter (if requesting Vendor reissue)

Warrant Number Warrant Date | Amount Payee ce} a2 ©
(starting with “37") (mm/dd/yyyy) (as it appears in Check Manager) 2 & 3
é

3700765762 05/16/2024 391.12 MISTY MOORE © O

©oU
©OU
©OU

Notes: CHECK LOST PLEASE REISSUE

District Approver: Date:
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.
MISTY MOORE : 5
NamaKiawnant (1), being first sworn, upon oath deposes and says:
On or about 05/16/2024 (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/ch efits aia: hint/Rer i in the sum of $ 391.12 (3)
Signed: UA nN ra ! i he (4)
4 3 ¢ % :

= = ]
( cribed and sworn to before me this ue day of Nau 2025.

Gi iy
JESSICA ZUNIGA
(Sie () Nota Putte hfe
My commission expires: wares ary
198, 20 (= Expires Aug 18, 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 Number _ |
(if known) (6) 3700765762

Original Date of Issue

tear 05/16/2024
Reason for original issue of Warrant/Check (8):

C Payroll / 5/15/25

O For Services or Goods furnished | .

XX Other: REIMBURSEMENT

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

5/15/25, 1:20 PM

Warrant (1 - mcto) - Warrant number: 3700765762, Stopped

ti Ld o

=| a

Warrant = Status Print = Attachments

v

Maintain __ New Status Setup Attachments _

3700765762

a Warrant header
General
Warrant number:
Holder:
Issued date: 5/16/2024 12:00:00 am
Status: Stopped

Exception flag:
Exception reason: None

Queued for positive pay:

Locked for reconcile:

Registered

Date registered:

No of days interest: 0
Annual interest rate: 0.00000

a Warrant Lines

[ri Amount Payee
391.12 MISTY MOORE

https://horizon.maricopa.gov/portal/webclient/#/desktop

VMware Horizon

Posting
Invoice:

Invoice date:

Paid date:

Positive pay sent date: 5/15/2024 09:00:16 am

Agency details
Agency voucher number: 2790
Agency claim number:

Agency low orig:

Agency PO number:

Agency sub fund:

Agency dept num:

Account

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