STAMPED & REDACTED - FOR AGENDA ATTACHMENT - NICHOLE HALE.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

Buckeye Union Dist #201 | Hale, Nichole 3700783781 $29.00

Date Sf

‘Amount

f Retssue: WT #

i
H
if

Finance Desk

Office of the Maricopa County
mm 20201016

School Superintendent

Warrant Void/Stop Request
Buckeye Union High School Dist. #201

District Name / Number: Attachments:

Contact Name: Laura Blake [ ] Original Warrant

Contact e-mail: Po Lost Warrant Affidavit (required for ALL reissues)

[] Vendor Letter (if requesting Vendor reissue)

Warrant Number Warrant Date..| Amount... Payee
{starting with “377: {rim/dd/yyyyy ; las tr appears in Check Manager)

Void
Step
e-issue

3700783781 07/25/2024 | 29.00 NICHOLE HALE © © LJ

©OU
©OU]
©OU

Notes: LOST CHECK IN MAIL. COUNTY WILL STOP AND WE WILL REISSUE

/) .
sates as . i] 4 .
District Approver: \—.""_, 4 }} Date: a A}
VAC (ole (0-10. ACR
For Internal Use Ont Ly i

Clerk of Board Date: Void Report Date:

Schools Affidavit/Claim Form

Application fora Duplicate Warrant/Check (definitions are on page 2)

STATE OF ARIZONA
COUNTY OF MARICOPA

NICHOLE HALE

Note: Numbers on this form correspond to numbers on the
instruction sheet which Is page 2 of this form,

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

Name/Clalmant

On or about 07/25/2024

(date}(2) a warrant/check was issued to the

above named person/entity in the amount as stated below. Such warrant/check was
elther never received or was subsequently inadvertently lost or destroyed and there is
no teasonable 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 $ 29.00 (3)
Signed: Wepete tate (4)
Tey
(5) Subscribed and sworn to before me this 6 day of Oot: 2024 .
NOTARY PUBLIC é SD ALYSSA ¥ S078

My Commission Expires

aeganey Notary Public - Martoopa County F
4) : Cosmiseion No, 595279 4
December 20, 2024 ;

My commission expires:
Byoj2a

(seal)

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

Waren nee [3700783781
Crane reno) [07/25/2024

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

O For Services or Goods furnished REFUND _
C1 Other; REFUND

10/22/24

S:\PROCESSES\Warrants ~ Duplicate or Stale\02 Forms\Schools\s irs
Revised June 2015

Service EASURER Q
( /, ee PHOENIX, ARIZONA DATE CONTROL NO.
i) ie ) INTEAEST SYOPS ON DATE FUNDS AVALABLE. (Se iPeas, ARSIaGY OND
\ Se, / 07/25/2024 201660436
(e)
as Buckeye Union High School District #201
WARRANT AMOUNT é
AY
$29.00

“Twenty Nine and 00/100*** Dollars

; VGID AFTER 365 DAYS

a

we) NICHOLE HALE
"HE wine
IRDER 1@) 5
Nad superitendent AEE SIGNATURES

oF
sete @ netertee = “ arin

07/25/2024 Check:

201660436 EXPENSE

MARICOPA COUNTY SCHOOLS + _PHOENDS ARIZONA __ap 20240724 B7O07S3781
NICHOLE HALE : nn ee |_o7/25/2024 + |
Pee ot Check Date | —
Account Number PO Number Invoice Amount
PY 250085 REFUND 43498, 23.00
i, AAdé led
aye
gjoulel
TOTAL: $29.90

VOUCHER: = 2840

HARLAND CLARKE 1422632 30106562

10/20/24, 10:00 AM VMware Horizon
Warrant {1 - mcto) - Warrant numben 3700783781, Stopped

| File = || “Warrant |

SR Geld v i} ;
aii Warrant | Status ; Print | Attachments
Maintain New | Status | Setup Attachments |
3700783781
“a Warrant header 7 ~
General Posting
Warrant number: 320078278), Invoice:
Holder: Invoice date:
Issued date: 7/25/2024 12:00:00 am Paid date:
Status: Stopped Positive pay sent date: 7f24/2024 09:00:05 am
Exception flag: Lf Agency details
Exception manors None Agency voucher number: 2840
Queued for positive pay: |-'| Agency clairn number:
. Agency low orig:
Locked forreconcile: | | Agency PO number:
Registered Agency sub fund:
Date registered: Agency dept nurn:
No of days interest: 0
Annual interest rate: 0.00000
« Warrant Lines —_ 7 _ ee
a) Amount : Payee Account

|

3} | Identification of the warrant

https://horizon.maricopa,gov/portal/webclient/#/desktop 1A