STAMPED & REDACTED JASON MICHAEL DEWEASE.PDF

INTEROFFICE MEMORANDUM 
TO: 
MARICOPA COUNTY CLERK OF THE BOARD 
FROM: 
MCSS FINANCE DESK (MIKE MARTINEZ) 
SUBJECT: 
AFFIDAVITS – REPLACEMENT OF LOST WARRANTS 
DATE: 
3/3/2022 
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 #1200. 
Thank you 
 
District 
Payee 
Warrant # 
Amount 
Queen Creek Unified #95 
Dewease, Jason Michael 
3700508091 
$502.81

Office of the Maricopa County
School Superintendent
District Nome / Number' QCUSD/095
Contoct Nome: Vicki Harberts-Gurule
District Approver:
Warran t Y oid / Stop Request
Financc Desk
rnm 20201016
osoo
contoct e-moil: vharbertsgurule@qcusd.org
Notes: Employee stated that he has not received check by mail and requested a re-issue.
Attochments:
t/
Originol Worront
Lost Worront Affidovit (required for ALL reissues)
Vendor Lelter (if requesting Vendor reissue)
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3700508091
Worrqnt Number
(siorting with "37")
21812022
Wqrront Dote
lnn/dd/yyyyl
$ 502.81
Amount
DEWEASE, JASON MICHAEL
Poyee
(os it oppeors in Check Monoger)
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Por Internal Use Onlr
Clerk of Boord Dote:
Void Report Dote:

Schools Affidavit/Claim Form
Application for a Duplicate Warrant/Check laetnttions are on page 2)
STATE OF ARIZONA
COUNTY OF MARICOPA
DEWEASE, JASON MICHAEL
nt
Note: Numbers on this form correspond to numbers on the
lnstruction sheet which is page 2 of this form.
(1), being first sworn, upon oath deposes and says:
On or about 21812022
(aate)(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/
be issued
in the sum of $ 502.81
(3)
(4)
Note.' Please attach a copy of the warant/check if available and/or any other
evidence that a warant/check was originally issued.
Reason for original issue of Warrant/Check (B)
E Payroll
n For Services or Goods furnished
n Other:
@
Brandi Moore
Notary Public
Maricopa County, Arizona
My Comm. Expires 04-15'25
Commission No. 600423
20 27.
5) Subscribed and sworn to before me this
day of
exprres:
(seal)
2
Vlarch
m
My
NOTAR
PUBLIC
Warrant/Check Number
(if known) (6)
3700508091
Original Date of Issue
(if known) (7)
21812022
S:\PROCESSES\Warrants - Duplicate or Stale\O2 Forms\Schools\Schools-Warrants 
Checks notice of claim.doc
Revised June 2015 
A.R.S. 1t-632 & 15-999

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