STAMPED & REDACTED - FOR AGENDA ATTACHMENT - HILLYARD OF ARIZONA.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: 08/30/2024

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

Osborn Dist #8 Hillyard of Arizona 3700771226 $568.90

Date

Amount

Reissue WT #

of the Maricopa C

100] Supe

Warrant Void/Stop Request

District Name / Number:
Contact Name:

Contact e-mail:

Attachments:
[| Original Warrant
Lost Warrant Affidavit (required for ALL reissues)

[] Vendor Letter (if requesting Vendor reissue)

Warrant Number Warrant Date | Amount
(starting with “37") (mm/dd/yyyy)

Payee

{as it appears in Check Manager)

Void
Stop
Re-issue

3700771226 |5/29/2024'|$ 568.90

HILLYARD OF ARIZONA O®

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Notes: hig not receive. Lost in the mail. Please reiséve.

District ee oh Vasemre

Doe: B{Bo|2Y

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.

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

Name/Claimant

On or about _ 5/29/24 (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

a be — y, him/her in the sum of $968. 90 (3)
Signed:\4 ; fh. |? (y Lise (4)
(5) Subscribed and sworn to before me this wt day of Stil, 20.
Jedi oan Dering
NOTARY PUBLIC <3
are
) SORTERSSIOICEX AIRES: MY COMMISSION EXPIRES NOVEMBER 9, 2024
llerya-
Lroa- BODY ae (seal)

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

Wanani/check Number 13790771226 |
Original Date of Issue / 99/9024 |

(if known) (7)

Reason for original issue of Warrant/Check (8):
0 Payroll
f@ For Services or Goods furnished HILLYARD OF ARIZONA

+ Other; HILLYARD OF ARIZONA

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

To Whom It May Concern:

This letter is to confirm that Hillyard of Arizona did not receive warrant/check #
3700771226, dated 5/29/24, for the amount of $568.90. The person that signed the
Affidavit (Marci Messner) is an authorized representative of Hillyard of Arizona.

Sincerely,

Bill Cook
Credit Manager

GIGDy, SCHOOL EXPENSE WARRANT WN 370071226

ae “y TREASURER OF MARICOPA COUNTY

’ 91-2/1221 5
jy elles Ut) festetenrotans ercany rou oe naman weuenosar ros DATE CONTROL NO. |
| ere INTEREST STOPS ON DATE FUNDS AVAILASLE. (SEC ARS1956)
C we 05/29/2024 8849383 | =
Oun =
Js OSBORN ELEMENTARY SCHOOL DISTRICT #8 °
PAY WARRANT AMOUNT A
“Five Hundred Sixty Eight and 90/100*** Dollars $568.90
VOID AFTER 365 DAYS
TO HILLYARD OF ARIZONA
ORDER /
F ul ods Steve Watso :
e) aan Superintendent ASF B eo SIGNATURES _ :
ee
05/29/2024 Check: 8849383 EXPENSE
MARICOPA COUNTY SCHOOLS - PHOENIX, ARIZONA AP 20240634 S77 1200
HILLYARD OF ARIZONA | | 05/29/2024 | |
Payee | | Check Date | |
Account Number PO Number Invoice Amount
, 240091 605491855 568.90
VOUCHER: 6140 TOTAL: $568.90

HARLAND CLARKE 226% 30106562

8/30/24, 12:55 PM

VMware Horizon

Warrant (1 - mcto) - Warrant number: 3700771226, Stopped

Warrant Status Print Attachments

v

Maintain New Status Setup Attachments
3700771226
« Warrant header
General Posting
Warrant number: Invoice:
Holder: Invoice date:
Issued date: 5/29/2024 12:00:00 am Paid date:
Status: Stopped Positive pay sent date: 5/31/2024 09:00:18 am

Exception flag:
<xception reason: None

Queued for positive pay:

-ocked for reconcile:

Registered

Date registered:

No of days interest: 0
Annual interest rate: 0.000(

4 Warrant Lines

C Amount Payee
568.90 HILLYARD OF ARIZONA

Agency details

Agency voucher number:
Agency claim number:
Agency low orig:
Agency PO number:
Agency sub fund:
Aaency dept num:

Account

Ka <del | 4 | © | Identification of the warrant

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