STAMPED & REDACTED - FOR AGENDA ATTACHMENT - BILINGUAL SLP SERVICES.PDF
Extracted text (via ocr_local)
4550 characters
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: 08/28/2024 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 Wickenburg Dist #9 Bilingual SLP Services 3700769485 | $1,930.50 Amount Date Reissue WT # Office of the Maricopa County Finance Desk School Superintendent amin 20201016 Warrant Void/Stop Request District Name / Number: Wickenburg Unified School District #9 Attachments: Contact Name: Lisa Smith [] Original Warrant Contact e-mo ID ee Lost Warrant Affidavit (required for ALL reissues) Vendor Letter (if requesting Vendor reissue) Warrant Number Warrant Date | Amount Payee (starting with “37") (mm/dd/yyyy) (as It appears In Check Manager) 2 £ 3 3700769485 / 9623303 | 5/23/2024 |$ 1,930.50 Bilingual SLP Services ©O © OU ©OU ©OU Notes: Lost check, please reissue District Approver: | Vara Sovuitiv. Date: glaxt ay 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 Note: Numbers on this form correspond to numbers on the COUNTY OF MARICOPA instruction sheet which is page 2 of this form. petted co Pediatric Therapies_(1), being first sworn, upon oath deposes and says: On or about 95/23/2024 (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. 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 $ 1,930.50 .(3) Signed: ee She. ———— (4) LZ. =Z (5) Subscribed and sw efore me this _-’8 day of Swaust 200% NOTARY PUBLIC CHERIE A SINCLAIR Notary Public, State of Arizona Maricopa County Commission # 616673 My Commission Expire(sqal) October 25, 2025 My 2 dla expires: 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 | 3700769485 / 9623309 Original Date of I: riginal Date of Issue | 05/23/2024 Reason for original issue of Warrant/Check (8): O Payroll & For Services or Goods furnished, O Other: 8/29/24 S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-\ 4 - Revised June 2015 7 Bilingual Pediatric Therapies SLP, OT, and PT 08/28/2024 To Whom It May Concern: This letter is to confirm that Richard Gallegos, CFO and owner of Bilingual SLP Services (Bilingual Pediatric Therapies), is an authorized signer for our company. If you require any further information or documentation, please fee! free to contact me directly. Thank you for your attention to this matter. Sincerely, ol Lu Lorrie Gallegos Clinical Director / Owner Bilingual Pediatric Therapies 8/28/24, 3:09 PM VMware Horizon Warrant (1 - mcto) - Warrant number: 3700769485, Stopped v- heed, Go =] @ Warrant Status Print = Attachments. Maintain New Status Setup Attachments 3700769485 4 Warrant header Warrant number: Invoice: Holder: Invoice date: Issued date: Paid date: Status: Stopped Positive pay sent date: — flag: EEO FER ON pone Agency voucher number: 2492 Queued for positive pay: Agency claim number: Agency low orig: Locked for reconcile: 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 oO Amount Payee Account 1,930.50 BILINGUAL SLP SERVICES 4d <4 Pm pl] VA | ll | Identification of the warrant https://horizon.maricopa.gov/portal/webclient/#/desktop 1/1