STAMPED AND REDACTED - HOPSKIPDRIVE.PDF

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: 11/19/2025

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

Tolleson Elementary Hopskipdrive 3700885535 $1,997.00

Date:

Amount:

Reissue WT #

\ . .
MA R) Cc fe) PA District #:
COUNTY

District Name; Tolleson Elementary School District #17

Contact Name: Adriana Hernandez

WARRANT VOID/STOP REQUEST

Warrant # 3700885535
Warrant Date 97/10/2025 Warrant Amount $ 1,997.00

Payee Hopskipdrive

Choose one option:
O 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:

Notes: check lost in the mail p of
District Approver: | es Aa Date: /6 / 31 | uS

Revised 10/8/2025

HopSkipDrive ae

October 13, 2025

Tolieson Elementary School District

To Whom It May Concern,

Please reissue warrant #3700885535, dated 7/10/2025 for $1,997.00, payable to
HopSkipDrive Inc. This warrant has never been received and is presumed lost in the
mail.

We certify the signer on the notarized affidavit, Sung Kim, is an authorized
representative of HopSkipDrive Inc and may communicate on behalf of our
company.

Thank You,

Joanna McFarland
CEO
HopskipDrive Inc

l
Schools Affidavit/Claim Form MARI 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.
HopSkipDrive Inc (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 §. 1,997.00 (3)

Signed: Kang Hom (4)

Print name: (required) ___Sung Kim

(5) Subscribed and sworn to before me this _30th

NOTARY PUBLIC

My commission expires:
11/05/2028

(seal)

Electronically signed and notarized online using the Proof platform.
Note: Please attach a copy of the warrant/check if available and/or any other evidence
that a warrant/check was originally issued.

Waren necembs | 3700885595 | a
nee |Or/ 1022025 ;
Reason for original issue of Warrant/Check (8):
O Payroll
isl For Services or Goods furnishedtransportation services
O Other:

S:\FinanceDesk\Schools-Warrants Checks notice of claim.docx

Revised May 2025 AR.S. 11-632 & 15-999

Warrant (1 - mcto) - Warrant number: 3700885535, Stopped

Warrant

Warrant Status Print Attachments

¥

Maintain New Status Setup Attachments
_| 3700885535
« Warrant header
General Posting
Warrant number: Invoice:
Holder: Invoice date:
Issued date: 7/10/2025 12:00:00 am Paid date:
Status: Stopped Positive pay sent date: 7/11/2025 09:30:32 am
— flag:
(cept son:
: seeaiuininants ae Agency voucher number: 2571
Queued for positive pay:

Agency claim number:
Agency low 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
oO Amount Payee Account

1,997.00 HOPSKIPDRIVE

Md

lq <4 Pm P| 7 | © | Identification of the warrant