STAMPED & REDACTED - FOR AGENDA ATTACHMENT - REBECCA L. MEDFORD.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: 05/03/2024

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

Saddle Mtn Dist #90 Medford, Rebecca L. 3700755459 $978.72

Office of the Maricopa County
School Superintendent

District Name / Number: oat Menton usd 4eQD

Contact Name: Sat aay Wickte

Warrant Void/Stop Request

Attachments:
C] Original Warrant
[| Infinite Visions Void Report

i Lost Warrant Affidavit (if requesting reissue}

CJ Vendor Letter (if requesting reissue for ¢ company)

Warrant Number Warrant Date Amount Payee
{sacting. with “377) (rum /ded /yyryy} jas it eppeors in Check Manager}
_S10015 5454 4-iu-ay [AIS n> | Benreea Lb. Med for4

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yo

Check here if requesting MCSS reissue the warrant: M

Notes:

District Approver: AO Kee —

Schools Affidavit/ Claim Form

Application for a Duplicate Warrant/ Check (etinitions 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,

¥ (1), being first sworn, upon oath deposes and says:

On or about | ito! 20224 (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, gr 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 $ V7 BO 12 (3)

Signed: Pobpp sar and Leal (4)

(8) Subscribed and sworn to before me this CAD. day of Ror hn 20+}.
. ane C

Ke ont expires: 7

REBECCA S| IMB
NOTARY PUBLIC- AR
cHARICOPA county

COMMISSION # 640069
MY COMMISSION EXPIRES
RIL. 10, A027

(seal)

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

MEE an {2100755 454

cronsumomey | 4 [Vol 2024

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

O Por Services or Goods furnished
O Other:

5/3/24

S\ PROCESSES Warrants « Duplicate or Stale\O2 Form. /
Revised June 2015 Me

513/24, 8:52 AM

| Warrant |

Warrant (f - meto) - Warrant number 3700755459, Stopped

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Maintain New Status | Setup | Attachments

3700755459

4 Warrant heador -
General Pasting
Warrant number 3200755459} Invoice:
Holder Invoice date:
Issued dates 4/16/2024 12:00:00 arm Paid date:
Status: Stopped Poxitive pay sent date: 4/14/2024 09:00:37 arn.
penton flag: Ld Agency details
Queued for positive pay: || Agency claim number:

Agency tow orig:

Locked for reconcile: || Agency PO number:
Registered Agency sub fund:
Date registered: Agency dept num:
No of days interest: 0
Annial interest rates 8.00000
o Amount | Payee Account

978.12 MEDFORD, RFBECCAL

I dm bt |” | 8 | identification of the warant

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