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INTEROFFICE MEMORANDUM
Maricopa County Schools Superintendent Office
TO: CLERK OF THE BOARD
FROM: Terri Ysaguirre
SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 8/6/2020
Please find attached 1 Affidavit/Notice of Claim(s) for lost warrants for inclusion on the next
available Board agenda
Vv The attached item(s) have been researched to ensure that the warrant(s) in question have
not been cashed or previously re-issued.
Vv The original warrant(s) have had a stop payment done.
If you have any questions, please contact Terri Ysaguirre at 602-372-1245 or via e-mail at
terri.ysaguirre@maricopa.gov. Approved Affidavits may be routed back to the Superintendent
of School Finance Division at 4041 N. Central Avenue #1200, (12th Floor)
Thank you.
#60 Higley Unified CDW Government Inc $372,053.49
7 RECEIVED seu
AUG 11 2020
MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS
Schools Affidavit/Claim Form
Application fora 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.
CDW Government Inc (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 93/ 10/2020 (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 $ 372,053.49 (3)
Signed: aN uf vas Klpo) — (4)
(5) Subscribed and sworn,to before me this 22 day of __ Jol u 2020 _.
Logs PUBLIC
JOHN M MAXWELL
My commission expires: Official Seal
a ! 7 . Notary Public - State of Illinois
“ 1 25 f 2025 My Commission Expires May 25, 2023 (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 37002931 31
(if known) (6) | DATA aug 22
Original Date of Issue 03/10/2020 | Sidi MG
(if known) (7) | 2 aes
Reason for original issue of Warrant/Check (8):
0 Payroll
li For Services or Goods furnished Computer items
O Other:
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc
Revised June 2015 A.R.S. 11-632 & 15-999
To Whom it May Concern,
This Letter authorizes that Melissa Brown, Sr. A/R specialist with CDW-Government, LLC is an authorized
signee for official documents associated for business finance purposes, on behalf of CDW-Government,
LLC Finance.
Sincerely,
te di
FY
Kathy Fleischman
Sr. A/R ,Erate Specialist
CDW GOVERNMENT, LLC
200 N. Milwaukee Ave,
Vernon Hills, IL 60061
kathfle@cdw.com
MARICOPA COUNTY SCHOOL SUPERINTENDENT
4041 N Central, Suite 1100
PHOENIX, AZ 85012
TO: PAYROLL —- ACCOUNTS PAYABLE
PLEASE STOP PAYMENT AND REISSUE THE FOLLOWING WARRANT:
DISTRICT NUMBER: {p0
PERSON REQUESTING
STOP PAYMENT: List Bale PHONE £494 - 7043 ext:
WARRANT NUMBER: _ 27 -002393)%] warrant DATE: OS) 10) JO
(prefix) (number) (mm) (dd) (yy)
PAYABLE TO: Cpw hovemment FN
AMOUNT: 3724, 653.7
FUND NO: Sto voucHerNno: _|0 / /
CHECK ONE: EXPENSE PAYROLL
i
\
REASON FOR STOP: Choay Jost 1 Now! Pleas Revoow
(LOST, DESTROYED, ETC.)
ONE ORIGINAL AFFIDAVIT AND ONE COPY OF THE AFFIDAVIT ARE ATTACHED. PLEASE
ISSUE A REPLACEMENT WARRANT.
(FOR COUNTY USE ONLY)
STATUS VERIFIED:
STOP DATE: REPLACED:
STOP VERIFIED: WARRANT #:
AFFIDAVIT SENT:
AFFIDAVIT APPROVED:
RECONS RETURNED: STOP PREPAID
Revised 4/5/07
\\Mcss_411\data\Repository\Share\PayRoll\Front Desk (finance) sample memos, etc\LOST WARRANT STOP-REISSUE COVER SHEET.doc