STAMPED & REDACTED - FOR AGENDA ATTACHMENT - WILLIAM SMITH NCHA BESONG.PDF

Office of the Maricopa County

School Superintendent
Steve Watson

INTEROFFICE MEMORANDUM

TO: MARICOPA COUNTY CLERK OF THE BOARD

FROM: MCSS FINANCE DESK (ANDIE DE LA ROSA)

SUBJECT: AFFIDAVITS -REPLACEMENT OF LOST WARRANTS

DATE: 11/08/2024

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 #21 Besong, William Smith Ncha 3700766800 | $10.683.48

Date

Arniount

Reissue WT #

Office of the Maricopa County
School Superintendent

Finance Desk
mam 20201016

Warrant Void/Stop Request

District Name / Number: BUCKEYE UNION H.S. DIST #201 Attachments:

Contact Name: MARY WICKANDER

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Original Warrant
Lost Warrant Affidavit (required for ALL reissues)

Vendor Letter (if requesting Vendor reissue}

Warrant Number’: <| Warrant Date: | Amount Payee
(starting with “37”) (ram/dd/yyryy} {as it appears in Check Manager)

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Void

Re-issue

3700766800 5/24/2024|$ 10,683.48, BESONG, WILLIAM SMITH NCHA|O ©

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Notes:

EE informed payroll on 10/30/24 that he lost his Balance of Contract check issued 5/24/24. He had thought he. Ux of

saved it, but now cannot find it. Treasurer has not cleared as of 10/31/24.

For Internal Use Ony
Clerk of Board Date: Void Report Date:

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Couns.

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.

WILLIAM SMITH NCHA BESONG (1), being first sworn, upon oath deposes and says:
Name/Clalmant

On or about May 24, 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/check be Issued to hiner in the sum of $ 10,683.48 (3)

me (4)

Signed: Lb Z

(5) Subscribed and sworn to before me this 31st day of October 20.24 .

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My commission expires:

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Note. Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.

Warenifimami [8700766800 / 201659516

ora Pemecn [06/24/2024

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

(1 For Services or Goods furnished
Other:

11/8/24

S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\S
Revised June 2015

41/8/24, 9:11 AM

Warrant (1 - mcto) - Warrant number: 3700766800, Stopped

A Warrant | _.

thi Warrant | Status | Print | Attachments

VMware Horizon

Maintain New Status | Setup | Attachments
3700766800
aWarantheader
General Pasting
Warrant number; 3700766800) Invoice:
Holder: Invoice date:
Issued date: 5/24/2024 12:00:00 arn Paid date:
Status; Stopped Positive pay sent date: 5/17/2024 09:00:16 am
espion flag: Ll Agency details
ception reason None Agency voucher number; 27
Queued for positive pay: | Agency claim number:
Agency low orig:
Lacked for reconcile: | $ Agency PO number
Registered Agency sub fund:
Date registered: Agency dept num:
No of days interest: o
Annual interest rate: 0.00000
4 Warrant Lines ~
im Amount . Payee Account

10,683.48 BESONG, WILLIAM SMITH NCHA

qd PT | oe” | 9) | feentification of the warrant

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