STAMPED & REDACTED - FOR AGENDA ATTACHMENT - CULLIGAN WATER.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 Culligan Water 3700747045 $67.70

Date

Amount

Reissue WT #

Office of the Maricopa County

School Superintendent

Warrant Void/Stop Request

District Name / Number: Osborn School District #8

Contact Name: Yyonne Lopez

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

3700747045|3/12/2024| $ 67.70 CULLIGAN WATER OO

© OU

©OO

©OU

Notes:

District sveronel (ohentve, Varies

Never received-Lost in mail. Please reissue.

dates Y/oy/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.

CULLIGAN WATER (1), being first sworn, upon oath deposes and says:
Name/Claimant

On or about 3/12/2024 (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, uncler 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 issued to him/her in the sum of $. 67.70 (3)
Ke, j
Signed: _/ ipl Tay lor (4)
(5) Subscribed and sworn to before me this ay cay of May 2024.
NOTARY PUBLIC
My commission expires: _ Notary Public
SHB 2. fl 227/2e¢S : fee ton 02-07-25 (seal)

Comanssion No, 327493

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 3700747045

(if known) (6)

Original Date of [ssue 03/12/2024

(if known) (7)

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

O Payroll
®& For Services or Goods furnished CULLIGAN WATER

=)

© Other: CULLIGAN WATER

'

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

You could give your people

Culligan Wala

Phone: as

To Whom It May Concern,

This letter is to confirm that Culligan Water did not receive warrant/check # 3700747045, dated
3/12/2024 for the amount of $67.70, and the person that signed the affidavit Meghan Taylor was an
authorized representative of Culligan Water.

Kevin Holman

Va

General Manager

SOMENT CONTAINS ACTRUE WATERMARK E HOLD TOLIGHTTO VIEWS pir =

SCHOOL EXPENSE WARRANT Ps 3700747045:
TREASURER OF MARICOPA COUNTY

PHOENIX, ARIZONA sr-2nizet DATE CONTROLNO. | =
_— a - 03/12/2024 8848714 | 2

OSBORN ELEMENTARY SCHOOL DISTRICT #8 ; _ ‘i

say WARRANT AMOUNT a
“*Sixty Seven and 70/100** Dollars $67.70 z

7 VOID AFTER 385 DAYS g

TO CULLIGAN WATER ( E
ORDER / 2
OF 5 Ss sea Get 9 Egon. IS 3
- AUTHORIZED SIGNATURES

= 03/12/2024 Check: 8848714 EXPENSE
MARICOPA COUNTY SCHOOLS + PHOENIX, ARIZONA AP 20240320 3700747045
CULLIGAN WATER | |_ 03/12/2024 | |
Payee | | Check Date |
Account Number PO Number Invoice Amount
[ft 240412 © 291X31638804 67.70

VOUCHER: 6103 TOTAL: $67.70

8/30/24, 12:42 PM VMware Horizon
Warrant (1 - mcto) - Warrant number: 3700747045, Stopped

Warrant

Warrant Status Print Attachments

¥
Maintain New Status Setup Attachments

3700747045

« Warrant header
General Posting
Warrant number: Invoice:
Holder: Invoice date:
Issued date: Paid date:
Status: Stopped Positive pay sent date:
Exception flag: Agency details
=xception reason: None Agency voucher number:
Queued for positive pay: Agency claim number:

Agency low orig:
-ocked for reconcile: Soe ts anes
Agency sub fund:

Registered Aaency dept num:
Date registered:
No of days interest: 0
Annual interest rate: 0.000(

4 Warrant Lines
C Amount Payee Account

Hq <= Dm PI | 4 | © | Identification of the warrant

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