STAMPED & REDACTED - FOR AGENDA ATTACHMENT - KELLI LYNN GILPIN.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: 10/29/2024

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

Litchfield Dist #79 Gilpin, Kelli Lynn 3700813854 | $2,111.14

Office of the Maricopa County
School Superintendent Warrant Void/Stop Request

Attachments:

District Name / Number: LESD #74 C] Original Warrant

Contact Name: Justia Steer [| Infinite Visions Void Report

nes [A] tow wore atten Uf eaves ss

[| Vender Letter (if requesting reissue for a company)

Warrant Number Warrant Date =. Amount Payee
{starting with “37") (mm /dd /yyyy) H (as it eppeors in Check Manager)
| Brposr3<o4 - tofz2/z024 | $2, Galan, Wells Lyan

t

i

|

Check here if requesting MCSS reissue the warrant: Q]

Notes:

Aa— a Date: iofz a[zowl

District Approver: 4

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,
K eli L Yan bilpia (1), being first sworn, upon oath deposes and says:
Name/Clalmdnt °
On or about _ |D/z2/ze2¢] (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 hi Fl the sum of $_2, Il i 3)

Signed Solu, >] _— (4)

(5) Subscribed and sworn to before me this _2 __day of Otlobsc 20 ay .

Llp (ho

NOTARY RUBLIC
BRITTANY CARTER
Notary Publio Arizona
icc] . un
My commission expires: Commiscion # boerA

vrel®, Doo°F f 7 thy Conn. Expires Jun. 18, 2027

(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 fel ~
(if known) (6) Broosi3stsd
Original Date of Issue
9 (if known) (7) lofrz/eord ov eeensnnte ree

Reason for original issue of Warrant/Check (8):
Ms Payroll
C1 For Services or Goods furnished

1 Other:

10/29/24

$:\PROCESSES\Warrants ~- Duplicate or Stale\02 Forms\Schools\Sch
Revised June 2015

10/29/24, 8:05 AM

Warrant | cs wees

[sa

bali Warrant | Status | Print

Warrant (1 - meto) - Warrant number: 3700813854, Stopped

VMware Horizon

Attachments
v
__ Maintain New Status | Setup I Attachments
3700813854
4 Warrant header
General Posting
Warrant number: 3700813854) Invoice:
Holder: Invoice date:
Issued clates 10/22/2026 = 12:00,00 am Paid cate:
Status: Stopped Positive pay sent date: 10/18/2024 = 09:00:12 am
Exception flag: | Agency details
Exception reason; None

Queued for positive pay: |]

Locked forreconcile: {|
Registered

Date registered:

No of days interest: 0
Annual interest rate: 0,00000

Agency voucher number: 9
Agency claim number:
Agency low orig:

Agency PO number:
Agency sub fund:

Agency dept nunt

“4 Warrant Lines

(J Amount | Payee
2,111.14 Gilpin, Kelli lynn

Iq qi ® Pl | e | 1") | Identification of the warrant

https://norizon.maricopa.gov/portalfwebciientv#/idesktop

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