STAMPED & REDACTED - FOR AGENDA ATTACHMENT - LIVING HEALTHY & ACTIVE LLC.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: 10/21/2024

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
Isaac Dist. #5 Living Healthy & Active LLC 3700797462 $6,000.00

Office of the Maricopa County Finance Desk

School Superintendent cpap 20201016

Warrant Void/Stop Request

District Name / Number TUL, Dot Attachments:
Contact Name: [ | Original Warrant
Contact ome AN \\ priscal A ost Warrant Affidavit (required for ALL reissues}
Vendor Letter (if requesting Vendor reissue)
o
3 Warrant Number Warrant Date .| Amount Payee ~~ a2 ©
a (starting with “37”) (mm/dd/yyyy) (as it appears in Check Manager} 2 FS FA
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4) or fpebyay "© | vvine Healthy 4 Actie LL
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“ore ost in ny moj |
District Approver: Nowy Qo Date: 10 ~Jb - QORY

For Internal Use Only

Clerk of Board Date: Void Report Date:

Reissue WT #

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
ee OF MARICOPA Instruction sheet which is page 2 of this form.
“
Vin althy t Aofwe (1), being first sworn, upon oath deposes and says:

xa nie
On or about _tfpafsoay (date)(2) a warrant/check was issued to the

above named persdn/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 $ @, 000.00 (3)
— ¢

Signed: 4
" aor ®

" (5) Subscribed and prom to before me this f 6™ day of :Oce# 2094.

NOTARY PUBLIC 4 ERICA COLE

Notary Public « Arizona

We 7 : c Maricopa County
ie ss . \ y, commission #462672
V7 Ae expires: My Comm, Expires Feb 25, 2028

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

rien 13100797463
Original Date of ante eels aay

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

7 For Services or Goods furnished.
O Other:

10/22/24

$.\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schoals\Sch
Revised June 2015

Office of the Maricopa County School Superintendent's Office (MCSS)

September 25, 2024

Dear MCSS Representative,

|, Estela Barraza, am an authorized employee of Living Healthy & Active LLC, a vendor
to Isaac Schooi District #5. | am writing to request a reissue of a check for $6,000
Control No. 46980 that was previously sent on 08/26/2024. Unfortunately, the original
check was sent to an incorrect address, and it has been close to a month with no
receipt of the check by either party.

Additionally, the suite number on the original check does not exist within our place of
business. As a result, | kindly request that a new check be issued to the correct address
provided below:

Living Healthy & Active LLC

Thank nt for your attention to this matter. Please feel free to contact me at |

if you need any additional information.

In great health and well-being,

ore

Estela Barraza, MS
Principal Workplace Well-being Consultant & Founder

9/30/24, 2:13 PM VMware Horizon
Warrant (1 - mcto) - Warrant number; 3700797462, Stopped h
: ff | Warrant |

ii Warrant | Status i Print | Attachments

|
|

|
: |
_ Maintain __|_ New | Status | Setup | Attachments | _ _ |
3700797462
General Posting
Warrant number: 3700797462 Invoice:
Holder; Invoice date:
Issued date: 8/26/2024 42:00:00 am Paid date:
Status: Stopped Positive pay sent clate: 8/27/2024 09:00:09 am
Pectin flag: | | Agency details
tion reason: f
ception rea em None Agency voucher number; 6229
Queued far positive pay: || Agency claim number:
Agency low orig:
Locked forreconcile: | | Agency PO number:
Registered Agency sub fund:
Date registerech Agency cept num:
No of days interest: 0
Annual interest rate: 0.00000
FD Wardant Linge ener ciecteneceeunennnannmne
oO Amount | Payee _ Account

6,000.00 LIVING HEALTHY & ACTIVE LLC Po

If <@ oc: eB Pl | 2 al | Identification of the warrant

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