STAMPED & REDACTED - FOR AGENDA ATTACHMENT - FORMS MANAGEMENT.PDF
Extracted text (via ocr_local)
4252 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: 07/25/2024
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 yy 08
via ¢-nail at i 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
Buckeye Union Dist #201 _| Forms Management 3700761522 $871.52
Office of the Maricopa County Finance Desk
School Superintendent msn 20201016
: Date
Amount.
~ Reissue WT #
District Name / Number:
Contact Name: Laura Blake
Contact e- mci:
Warrant Void/Stop Request
Buckeye Union High School Dist. #201
Attachments:
[ | Original Warrant
Lost Warrant Affidavit (required for ALL reissues)
[| Vendor Letter (if requesting Vendor reissue)
{Warrant Number [Warrant Date |, Amount [Payee ee ee
| (starting with 837") oo (mm/t ad/yyry) ‘ {as it appears i Check | Menscer| 2 & 2
; ee - o
"4
3700761522 05/03/2024 871.52 FORMS MANAGEMENT
Notes: LOST IN MAIL
District Approver: * =
A Beet wD Cal DEY
OL F ROGL
For Internal Us Oy
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.
FORMS MANAGEMENT
NenierCTaTant (1), being first sworn, upon oath deposes and says:
On or about MAY 03, 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
issued to hi
er inthe sum of $__ 871-52 (3)
(4)
wo Ty
NOTARY PUBLIC
an Subscribed “ih sworn to before me this \(~ day of Mlipe 2024 .
My lawns expires:
[0:20:2
(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
(if known) (6) 3700761522
Original Date of Issue
(if known) (7) 05/03/2024
Reason for original issue of Warrant/Check (8):
O Payroll
KX For Services or Goods furnished
O) Other:
7/25/24
S:\PROCESSES\Warrants ~ Duplicate or Stale\02 Forms\Sch ; =
Revised June 2015
Forms Management Services
jena
To Buckeye Union High School District,
| Penni Blaisure, Owner of Forms Management never received the payment for invoice
numbers 120332 $152.04 and 120387 $719.48 that was sent to us on May 3 2024
Please Advise next steps
Thank you
Penni Blaisure
Owner
Forms Management Svc
Hospital Forms Svc
Office
Cell-
7124124, 4:27 PM VMware Horizon
Warrant (1 - mcto) - Warrant number: 3700761522, Stapped
oy Warrant
| He] ja) P|
tii Status | Print | Attachments
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Maintain New Status | Setup | Attachments
3700761522
4 Warrant header
General Posting
Warrant number: Invoice:
Holder: Invoice date:
Issued clate: 5/2/2024 12:00:00 am Paid date:
Status: Stopped Positive pay sent cate: 5/1/2024 09:00:33 am
Exception flag: || Agency details
Exception reasons None Agency voucher number: 2781
Queued for positive pay: }j Agency claim number:
Agency low orig:
Locked forreconcile: | | 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
CI] Amount — Payee Account
| 9) | Identification of the warrant
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