STAMPED & REDACTED - FOR AGENDA ATTACHMENT - RIVERA SIEDAH.PDF

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: 04/29/2024

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

Queen Creek Dist #95 Rivera, Siedah 3700732640 $135.00

' Date

Amount ”

Reissue WI #

Office of the Maricopa County Finance Desk

School Superintendent nam 20201016

Warrant Void/Stop Request

District Name / Number: QCUSD 95 Attachments:
Contact Name: ANDRIA JOHNSON [| Original Warrant

Contact o- moi ie | Lost Warrant Affidavit {required for ALL reissues)

[| Vendor Letter (if requesting Vendor reissue)

"Warrant Number | Warrant Date * Amount | Payee +7 2 ©
{storting with “37") (nin/dd/yyyy) (os it appears in Check Manager} 6 2 a
> n 2

o

ax

3700732640| 1/25/2024 $ 135.00 RIVERA, SIEDAH O@Vv

Notes: WWARRANT WAS LOST IN THE MAIL

District Approver: Z Pa Date: dy /, ks fh

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.

Rivera, Siedah (1), being first sworn, upon oath deposes and says:
Name/Clalmant

On or about 01/25/2024 (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

warrant/check be issued to mee of $135.00 (3)
Signed: Steg kK A (4)
(5) Subscribed and sworn to before me this Z6 day of Proc. \ 2024.
NOTARY PUBLIC Brandi Moore
Notary Publle

Maticopa County, Arizona
My commission expires: My Cotnin. Expitee oan 5.26
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(aWal

Note, Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.

W Check Numb: i
weNfoman 3700732640

Original Date of oe" (01/25/2024

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

O For Services or Goods furnishedParent Refund
f= Other: Parent Refund

4/30/24

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

4/29/24, 8:32 AM

Warrant (1 - mcto) - Warrant number: 3700732640, Stopped

| Warrant |
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Warrant | Status | Print
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Maintain New Status

Attachments

Setup | Attachments

VMware Horizon

3700732640

4 Warrant header
General

5700732640)

Warrant number:

Holder:

Issued date: 1425/2024 12:00:00 am
Status: Stopped

Exception flag: if

Exception reason: None

Queued for positive pay: |.“

Locked for reconcile: {'}
Registered

Date registered:

No of days interest: 0

Annual interest rate: 0.00000

4 Warrant Lines

0 Amount | Payee
135.00 RIVERA, SIEDAH

i <f

https://horizon.maricopa.gov/portalwebclienti#/desktop

& Pl | | 8) | teentification of the warrant

Posting

Invoice:

Invoice date:

Paid date;

Positive pay sent date:

1/26/2024 12:00:06 pm

Agency details

Agency voucher number: 7144
Agency claim number:

Agency low orig:

Agency PO number:

Agency sub fund:

Agency dept num:

Account

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