STAMPED & REDACTED - FOR AGENDA ATTACHMENT - 3700751442 - THOTH IMMANUEL.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 Immanuel, Thoth 3700751442 $82.74

Amount Date

Relssue WT #

Office of the Maricopa County

School Superintendent

District Name / Number: SMUSD 90
Contact Name: Crystal Mondragon

Warrant Void/Stop Request

Finance Desk
mien 20261016

Attachments:
| Original Werrant

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

Warrant Date

Warrant Number Amount Payee zs 2 @®
(sorting with “377) (oen/ad/rrrn) {fos ft appoors ia Check Manager! 2 3 z
3700751442| 4/3/2024 | $ 82.74 IMMANUEL, THOTH 0 ©

Notes: Checks were being sant to the wrong home address.

District Approver:,

. Date: 5/3/2024

Clerk of Board Date:

For Internal Use Only

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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.
IMMANUEL, THOTH (1), being first sworn, upon oath deposes and says:

Name/Claimant

.

On or about Aga anol (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

7 to him/her in the sum of ¢$82. 74 (3)

Signed: (4)

(5) Subscribed and sworn to before me this 3 day of _M a4 20 ad,

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NOTARY PUBLIC

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My commission expires:
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Note. Please attach a copy of the warrant/check if available “SHY B any other

evidence that a warrant/check was originally issued.

Wi t/Check Numb:
arrant/Check Number 13700751442

Original Date of Issue
ae moma) 4/03/2024

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

For Services or Goods furnished REIMBURSEMENT
O Other; REIMBURSEMENT

S:APROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\s

Revised June 2015 B° / i} / 24

5/3/24, 3:08 PM VMware Horizon
Warrant (1 - mcto} - Warrant number: 3700751442, Stopped
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3700751442
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General Posting
Warrant number: 3700791442) Invoice:
Holder; Invoice date:
Issued date: 4/3/2024 12:00:00 arn Paid date:
Status: Stopped Positive pay sent date: 4/4/2024 09:00:11 am i
fxception flag: I Agency details
Exception reason: None

Agency voucher number: 2484
Agency claim number;
Agency low orig:

Queued for positive pay: ||

Locked for reconcile: | |

Agency PO number:
Registered Agency sub fund;
Date registered: Agency dept num:
No of days interest: 0
Annual interest rates 0.00000
4 Warrant Lines
‘ma Amount | Payee Account

82.74 IMMANUEL, THOTH

bf i bl | 2° | 19) | tdentification of the warrant

https://horizon.maricopa.gov/portalwebclient#/desktap 14