WIST.PDF

Maricopa County — Formal (2020-09-02)

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INTEROFFICE MEMORANDUM

Maricopa County Schools Superintendent Office

cn
RECENED atthe
TO: CLERK OF THE BOARD nua 18 2028 ror
FROM: Terri Ysaguirre

aOQUNTY
MARIC OPA CO NpERVISORS
SUBJECT: Affidavits — Replacement of Lost Warrants CLERK BOARD
DATE: 8/17/2020
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 Wist $813.93

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.

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

On or about 12/11/2019 (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 $813.93 3)
Signed: f (4)

__\\

(5) Subscribed and sworn to before me this _\‘!_day of PUGUS) 20.90 .

NOTARY PUBLIC U

NINA A. SCALZO
My commission expires: NOMTARIGOPAGOUNTY
\ i a 2033 Expires November? 2028 (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 3700260937

(if known) (6)

Original Date of Issue yy)
(if known) (7) 1 2/1 1/1 9 aa

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

For Services or Goods furnished Office supplies
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

“WwisT

Business Supplies & Equipment

ave 2 1 2020

ices
August 7, 2020 Fi nancial Servic

To Whom It May Concern:

A check from Higley Unified School District was lost in the mail.
Please see the enclosed for the signed affidavit. Peter Drozdowicz is authorized to sign this
affidavit for Wist Supply & Equipment.

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: lic

STOP PAYMENT: iS! EATIE PHONE #( +) 279 -7043 ext:

WARRANT NUMBER: _ 277 - O02. (0°37 WARRANT DATE: Say MAD
(prefix) (number) (mm) (dd) (yy)

PAYABLE TO: Wist

AMOUNT: $15-93

FUND NO: Co | VOUCHER NGS es

CHECK ONE: EXPENSE PAYROLL

K

REASON FOR STOP: .
Check. Lost im Maic~ PLEASE REISS0F

(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