STAMPED & REDACTED - FOR AGENDA ATTACHMENT - WEST VALLEY ROCK.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

Saddle Mtn Dist. #90 West Valley Rock 3700795999 $853.24

Date

Amount

Reissue WT #

Gifice of the Maricopa County
School Superintendent

District Name / Number: SMUSD 90

Contact Name: Crystal Mondragon

Warrant Void/Stop Request

Finance Desk
man 20201016

Attachments:

Original Warrant

Lost Warrant Affidavit (required for ALi reissues}
Vendor Letter (if requesting Vendor reissue)

Warrant Number Warrant Date | Amount Payee me) a2 8
isarting with “377 (mm/dd/yyyy) {es it appears in Caeck Manager} 2 2 2

é
3700795999) 8/21/2024 | $ 853.24 West Valley Rock O ©

@oOu

©O0

@©O0

Notes: Check was lost in the mail.

tld

District Approver:

Date: 40/17/2024

For Internal Use Only

Clerk of Board Date:

Void Report Date:

Schools Affidavit/Claim Form

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

STATE OF ARIZONA
COUNTY OF MARICOPA

WEST VALLEY ROCK

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/Claimant

On or about Sepemrber 3) 2004 nna 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 fost 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 clalm 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 $9853.24 (3)
a
Signed: Po@ey NASH (4)

em Sep before me this A\_day of 0 Une 22h.

NOTARY PUBLIC

My, commission expires:
WAG" 202.1

CCA _ MONTES
note BES Pablio, State of Arizone
Marloopa County

samisslon 649023
Mircommission Explres
Mey 20, 2027

Note, Please attach a copy of the warrant/check if available and/or any other

evidence that 2 warrant/check was originally issued,

Warrant/Check Number 3700795999

Original Date of Ussue 8/21/2024

Reason for origina! issue of Warrant/Check (8):

Payroll

@ For Services or Goods furnished MATERIALS

CD Other: MATERIALS

Si\PROCESSES\Wartants - Ouplicate or Stale\02 Forms\$chools\Schools-Warrants Chee!

Revised June 2015

10/22/24

CUSTOM LANDSCAPE

MATERIALS
October 9, 2024

Saddle Mountain Unified School District
38201 W. Indian School Rd.
Tonopah, AZ 85354

Re: Application for a Duplicate Warrant / Check authority

West Valley Rock is submitting a claim form to the State of Arizona, County
of Maricopa for check #3700795999 in the amount of $853.24, original date of
check 8/21/2024, West Valley Rock never received check 43700795999 in the
mail, Bobbi Nash is an authorized representative of West Valley Rock, job title
Controller. Please see attached signed, and notarized claim form.

Thank you,

oom Schiopan
President
Custom Landscape Materials dba West Valley Rock

Physical:

10/20/24, 11:07 AM VMware Horizon
Warrant (1 - mcto) - Warrant number: 3700795959, Stopped
, s | Warrant |

PA sis

li Warrant | Status j Print

Attachments | |
nd \ |
Maintain | Status | Setup |
3700795999
4 Warrantheader
General Posting
Warrant number: 13700795999) Invoice: '
Holder: Invoice date:
issued date: 8/21/2024 42:00:00 am Paid date:
Status: Stopped Positive pay sent date: 8/22/2024 09:00:26 am
Exception flag: i Agency details
Exception reason: Mone

Agency voucher number: 2506

Queued for positive pays | j Agency claim number
; Agency lew orig:

Lockedforreconcile: | | Agency PO number:

Registered Agency sub fund: i

Date registered; Agency dept num:

No of days interest: 0

Annual interest rate: 0.00000 :
4 Warrant Lines

oO Amount Payee Account

: pe Pl { eo | ay | Identification of the warrant

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