STAMPED AND REDACTED - TRAVIS WHITEHEAD.PDF

Maricopa County — Formal (2025-12-10)

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v
MAR)COPA
COUNTY

INTEROFFICE MEMORANDUM

TO: MARICOPA COUNTY CLERK OF THE BOARD
FROM: MCSS FINANCE DESK (MIKE MARTINEZ)
SUBJECT: AFFIDAVITS — REPLACEMENT OF LOST WARRANTS

DATE: 11/13/2025

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 Unified #95 WHITEHEAD, TRAVIS 3700916375 $560.06

Date:

Amount:

Reissue WT #

\ . . .
COUNTY

District Name: QCUSD 95

Contact Name: Kathy Saxton

Contact Email: rT sCSYS
WARRANT VOID/STOP REQUEST

Warrant # 3700916375

Warrant Date 10/28/2025 Warrant Amount $560.06

Payee Travis W Whitehead

Choose one option:
oO Void Warrant
Warrant is in possession of the district and will be sent back to MCSS Finance Desk with the next
available courier run.
@) Stop Warrant
Warrant has been lost or destroyed and is not in possession of the district.

If requesting MCSS to reissue this warrant select the Reissue Warrant box below and submit a
notarized affidavit along with a vendor letter (if payee is not an individual).

Reissue Warrant: /] void 11/13/2025 - MM

Notes: Check was lost in the mail

District Approver: Rade Date: \V (0 as

Revised 10/8/2025

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.
WHITEHEAD, TRAVIS W (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about \Ola8| 2095 (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 $ $560.06 (3)

Signed: SS (4)

(5) "| ed and sworn to before me this_(()__day of (NOVember 20 OS.

NOTARY PUBLIC

My commissjon expires:
05, Io [2021p

CASSANDRA KENNEDY
Notary Public - State of Arizona
PINAL COUNTY
Commission # 626036 (seal)

Expires May 8, 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 Number | 3799916375

(if known) (6) ’ 11/14/25
Original Date of Issue WEXSEKRE i
(if known) (7) 10/28/2025

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

O For Services or Goods furnished
O Other:

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

11/13/25, 11:07 AM Maricopa County - Treasurer's Office - Agency Web

Warrant Maintenance

New Warrant Upload Warrants

UEEN CREEK UNIFIED

Amount

$560.06

Payee Name

WHITEHEAD, TRAVIS W

OPTIONAL)

< Back To Warrant Search

https://treasurer.maricopa.gov/agencyweb/WarrantMaintenance/Warrants/650744

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