STAMPED & REDACTED - FOR AGENDA ATTACHMENT - DAVID K ELLIS.PDF
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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 Buckeye Union Dist $201 | Ellis, David K 3700760137 $761.69 Date Amount Reissue WT # Office of the Maricopa County School Superintendent Contact Name: MARY WICKANDER Finance Desk mrm 20201016 Warrant Void/Stop Request District Name / Number: BUCKEYE UNION HS DISTRICT 201 Attachments: [| Original Warrant Lost Warrant Affidavit (required for ALL reissues) [ ] Vendor Letter (if requesting Vendor reissue) Warrant Number Warrant Date | Amount _ +} Payee Ss 2 @ frortg wih a7) (mm/dd/yy) (as tr eppenrs io Check Monoger 2 & Fs 3700760137 |4/30/2024|$ 761.69 ELLIS, DAVID K © ©) Notes: s EEIDAVIT ATTACHED. CK HAS NOT CLEARED TREASURER. District Approver: Lpg Ye Y A. Ae Te ie Date: 5/75/2024 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. David K. Ellis (1), being first sworn, upon oath deposes and says: On or about 64/30/2024 (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 eM 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 $761. 69 (3) Signed: “2 go (4) (5) Subscribed and sworn to before me this qm day of “Dfasts 20.a4. Sousa. Vi NOTARY PUBLIC My commission expires: H2jro2y (seal) Note, Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. W t/Check Numb arrantiCheck Number 13700760137 iginal Date of I: Original Date of Issue [94/30/2024 Reason for original issue of Warrant/Check (8): Payroll O For Services or Goods furnished. 01 Other: 5/17/24 S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\S Revised June 2015 5/16/24, 11:02 AM Warrant (1 - meta) - Warrant number: 3700760137, Stopped wv VMware Horizon ea iz, Oy oS . a | | | Lili: Warrant | Status | Print | Attachments v Maintain New Status | Setup | Attachments 3700760137 “a Warrant header 0 oe General Posting Warrant number: 3700760137] Invoice: Holder: invoice date: Issued clate: 4/30/2024 42:00:00 am Paid date: Status: Stopped Positive pay sent date: 4/26/2024 09:00:49 am Exception flags | Agency details Exception reason: None Agency voucher number: 24 Queued for positive pays | “1 Agency claim number: Agency low arig: Locked for reconcile; I Agency PO number: Registered Agency sub fund: Date registered: Agency dept nun No of days interest: 0 Annual interest rate: 0,00000 4 Warrant Lines — oO Amount Payee | Account 761.69 ELLIS, DAVID K oor teeeeeeernemnrnne Iq <q bm bl | 2? | 5) | Identification of the warrant https://norizon.maricopa.gov/portal/webclienv#/desklop qi