STAMPED & REDACTED - FOR AGENDA ATTACHMENT - LISSETH O LOPEZ.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: 10/28/2024

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

Fowler Dist #45 Lopez, Lisseth O 3700807807 $1,872.85

Date

Amount

Reissue. WT #

Office of the Maricopa County

School Superintendent

Contact Name: YVETTE ORTIZ

Finance Desk
mun 20201016

Warrant Void/ Stop Request

- District Name / Number: FOWLER ELEMENTARY SCHOOL DIS

Attachments:

Original Warrant

WU | Lost Warrant Affidavit (required for ALL reissues}

Vendor Letter (if requesting Vendor reissue)

Werrant Number | | Warrant Date} Amount |} Payee. cee Bw
as mn er care : : ences) o : Pin [les toe ero ate et) 3 2 ; 2
3700807807 10/1/2024 1,872.8! LOPEZ, LISSETH O Oow

Notes: _OST CHECK - REISSUE WARRANT

| District Approver: YVETTE ORT eK Date: 10/21/2024

For Internal Use Only

Clerk of Board Date:

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Void Report Date:

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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.

LOPEZ, LISSETH O

Name/Claimant

On or about 10/01/2024 (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.

(1), being first sworn, upon oath deposes and says:

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

warantcheck be: issued to him/her in the sum of 91872. 85 : (3)

Signed: __&- Lopes : : (4)

(5) Subscribed and sworn to before me this -} day of OY: 202’.

Ze. LEZ a

NOTARY PUBLIC

OSCE "ON UO|SEUWOD

jecy, ; . -G}-20 SONGS WWD AN Age ‘
My ommission expires: . betadis ‘Aun0g edoopeyy “( i .
f : anand Arion art (seal)
OYOBUTED AYOWL, MONTE .

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

wretitim 63700807807
Original Pate roe 10/01/2024

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

O For Services or Goods furnished
() Other:

10/29/24

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

10/28/24, 9:32 AM
Warrant (1 - mcto) - Warrant number: 3700807807, Stopped
Warrant |

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3700807807

4 Warrant header
General Pasting
Warrant number: 3700807807; Invoices
Hol¢ler; Invoice date:
Issued clate: 10/1/2024 12:00:00 am Paid clate:
Status: Stopped Positive pay sent date: 9/27/2024 09:00:06 am
Exception flag: | Agency details
Exception reason; None Agency voucher number: 11
Queued for positive pay: }-“] Agency claim number:

Agency low arig:

Locked forreconcile: | | 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 7 a a
O Amount ° Payee Account

1,872.85 LOPEZ, LISSETH O

Iq ois Bm bl | ra { pj | Identification of the warrant

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