STAMPED & REDACTED - FOR AGENDA ATTACHMENT - CHARLENE BELLAMY.PDF

Maricopa County — Formal (2024-09-11)

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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

Littleton Dist #65 Bellamy, Charlene 3700785998 $1,835.55

Schootbistict "| Le ” Lh hen =. MCESA Stop/Cancel/Void Form

. 3 Education. Service Attachments: } Original Warrant
District # |. LOS vo Agen ae
Voucher Number Af tS one
; Fund Cee MICR Number ; Amount Warrant Date System Generated Warrant # Payee
ee LALOR Fe | “3 256S- | [7afod_] [. BILLA EEO | \LBetlitic: DA ZZ
— Lo i | im Te :
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Reason for Stop, Cancel or Void: Ty check here if to be reissued by MCESA
CV AN
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~ Approved By: — | yo
StopCancelReleaseF orm pdf aled pprovedi By: f(s | Date: S419

11/14/11

Schools Affidavit/Claim Form

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

STATE OF ARIZONA Note: Numbers on this form correspond to numbers on the
NTY OF MARICOPA Instruction sheet which Is page 2 of this form.

o9
a y
Mele Lb Lo rues, being first sworn, upon oath.deposes and says:

On or about hy ZL 22 (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, clalmant hereby affirms that this clalm Is correct
and the amount shown Is due and owing, and the applicant requests that a replacement

warrant/ch Ck 7 to him/her Jp the sum of i, 35 (3)

Signed: (4)

(5) Subscribed and sworn to sworn to before me this / 31) day of Aul Laut wed

J Yawn) | A ters }

NOTARY PUBLIC ov

MARIA D: KRIEGER
Notary Public - State of Arizona
Is} MARICOPA COUNTY
<’: Commission # §97913
Expires February 01, 2026.

My commission expires:
Pe bined. op, 2025

Note, Piegse attach a copy of the warrant/check | If available and/or any other
evidence that a warrant/check was originally issued,

Warrant/Check Number a ey =
Sogn SID OUVES IFS

Original Date of Issue 3 ,

ane hows) July If) 202
Reason for original Issue of Warrant/Check (8):

Payroll
O For Services or Goods furnlshed___
) Other:
8/19/24

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

8/19/24, 9:48 AM
Warrant (1 - mcto} - Warrant number: 3700785998, Stopped
| Warrant |

Va feta

VMware Horizon

iad Warrant | Status | Print | Attachments
__.Maintsin |New _ | Status | Setup | Attachments
3700785998
4 Warrant header
General
Warrant number: 3700785998)
Holder:
Issued date: 7/31/2024 12:00:00 am
Status: Stopped
Exception flag: |
Exception reason: None

Queuedl for positive pay: kt

Locked forreconcile; | |
Registered

Date registered:

No of days interest: 0
0.00000

Annual interest rate:

Pasting
Invoice:
Invoice cate:
Paid date:

Positive pay sent date: 7/29/2024

Agency details

Agency voucher number 4
Agency claim number:
Agency low orign

Agency PO number:
Agency sub fund:

Agency dept num:

09:00:30 am

4 Warrant Lines

oO Amount | Payee
1,835.55 BELLAMY, CHARLENE

hitps://horizon.maricopa.gov/portalAvebcllenv/#/desktop

i bl | “ | 8) | Identification of the warrant

Ww