STAMPED & REDACTED - FOR AGENDA ATTACHMENT - CORI HEINE.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: 08/19/2024

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

Queen Creek Dist #95 Heine, Cori 3700788276 $1,767.92

Date

Amount

Relssue WT #

Office of the Maricopa County

School Superintendent

District Name / Number: 95/QCUSD

Contact Name: Kathy Saxton

Warrant Void/Stop Request

Finance Desk
mam 20201016

Attachments:
LJ Original Warrant

Lost Warrant Affidavit (required for ALL reissues)

L | Vendor Letter {if requesting Vendor reissue)

Warrant Number

Warrant Date

Amount Payee

Void
Stop

(starting with “37") {mm/dd/yyyy) (es it appears in Check Manager) 2
3700788276 8/6/2024 | $ 1,767.92 HEINE, CORI OOM

©OU

@OU

@®O0

Notes: Employee recycled check in error. Please reissue.

District Approver: ado Date: Z (7 24

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,

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

On or about 3 (} add Y (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 $. 1,767.92 (3)

Signed: ( (ou erry (4)

(5) wes sworn to before me this _ | ES day of- f Wy UST 20 RAR-

NOTAR¥PUBLIC

CASSANDRA KENNEDY
a . Notasy Public - State of Arizona
My commissign expires: PINAL COUNTY
, Commission # 629036
B Ha) Expires May 8, 2098 (seal)

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 -
aan fe. bik er 3700788276

Original Date of Issue
g (if known) (7) 8/6/2024

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

For Services or Goods furnished
O Other:

S\PROCESSES\Warrants - Duplicate or Stale\02 Forms\; 8/19/24
Revised June 2015 /

8/19/24, 10:40 AM VMware Horizon
Warrant (1 - mcto) - Warrant number: 3700788276, Stopped
se | Warrant |

Warrant | Status | Print | Attachments |
Maintain New Status | Setup | Attachments } __. _
3700788276
“a Warrant header ~
General Posting
Warrant number: 3700788276) Invoice:
Holder: invaice date:
Issued clate: 8/6/2024 12:00:00 am Paid date:
Status: Stopped Positive pay sent cater 8/2/2024 09:00:01 am
center flag: | Agency details
ti SCH:

*cepton rea u None Agency voucher number: 4

Queued for positive pay: i| 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: 9,00000

4 Warrant Lines

im Amount : Payee Account

Iq qi. & Bl | eo | Sj | Identification of the warrant

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