STAMPED & REDACTED - FOR AGENDA ATTACHMENT - ELIZABETH SMITH.PDF

Maricopa County — Formal (2024-06-12)

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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: 05/16/2024

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

Paloma Dist #94 Smith, Elizabeth 3700668789 | $1,079.05

Date

Amount

Reissue WT #

Office of the Maricopa County

School Superintendent

Finance Desk
nim 20201016

Warrant Void/Stop Request

District Name / Number: Paloma School District #94

Contact Name: [rma Garcia

Attachments:

[| Original Warrant

Lost Warrant Affidavit (required for ALL reissues)
[] Vendor Letter (if requesting Vendor reissue)

Warrant Number Warrant Date | Amount
(storting with “37") (mm/dd/yyyy)

Payee
(as it appears in Check Manager)

Void
Stop

3700668789) 7/12/2023 | $ 1,079.05

Elizabeth Smith = ©O

Notes:

District vowroree (UNG Diwit.

pore: 05|15] 2004

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.

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

On or about 1 jalaoaz (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 ¢1079.05 (3)

Signed: GS Caglinlfasull. (4)

(5) Subscribed and sworn to before me this |5@ day of ly ay 2aY.
OITA Ur A

NOTARY PUBLIC

My en SESS

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 1370668789 _

oo ee =r 12/2023

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

O For Services or Goods furnished
a

= other: VElMbwsenwnb

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

5/16/24, 3 26 PM

Warrant Status Print Attachments

v

Warrant (1 - mcto) - Warrant number: 3700668789, Stopped

VMware Horizon

Maintain New Status Setup Attachments
3700668789
4 Warrant header
General Posting
Warrant number: Invoice:
Holder: Invoice date:
Issued date: 7/12/2023 12:00:00 am Paid date:
Status: Stopped Positive pay sent date: 7/13/2023 09:00:07 am
Exception flag:
E ti ;
en eee tone Agency voucher number: 1103
Queued for positive pay:

Locked for reconcile:

Registered

Date registered:

No of days interest: 0
Annual interest rate: 0.00000

4 Warrant Lines

oO Amount Payee
1,079.05 ELIZABETH SMITH

Agency claim number:
Agency low orig:
Agency PO number:
Agency sub fund:
Agency dept num:

Account

lq <4 > DI | 7 | ® | Identification of the warrant

https //horizon maricopa gov/portal/webclient/#/desktop

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