STAMPED & REDACTED -FOR AGENDA ATTACHMENT - SAMANTHA MILLER.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: 04/16/2024 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 Nadaburg Dist #81 Miller, Samantha 3700744360 $97.99 Date Amount Office of the Maricopa County School Superintendent Warrant Void/Stop Request District Name / Number: Nadaburg USD #81 Contact Name: Gerri-Ann Whigham Cone < e Finance Desk mam 20201016 Attachments: [| Original Warrant Lost Warrant Affidavit (required for ALL reissues) Vendor Letter (if requesting Vendor reissue) Warrant Number Warrant Date "Amount Payee (starting with “37"} tmm/dd/yyyy) fash appears in Check Manager! A _ 8 s a 3 '3700744360| 3/6/2024 | $ 97.99 Samantha Miller Oke) Oxe}m) @OU @©@OU Notes: Vendor accidently shredded the check. please reissue District Approver: Au hyaaby Date: 4/46/2024 ;. Reissue WT #.- 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. Samantha Miller i . anvayClamene (1), being first Sworn, upon oath deposes and says: On or about 93/06/2024 (date)(2) a warrant/check was issued to the above named person/entity in the amount as stated below. Such warrant/check was 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 $97.99 (3) Signed: KL Wh- (4) ° PA (5) Subscribed and sworn to before me this day of Ag. N 22. a —_ NOTARY PUBLIC My commission expires: ¥ Non earn 5 - - SJ Marico, 2-19-2027 Expires aoe os itea7 318 (seal) Note: Please aitach a copy of the warrant/check if available and/or any other evidence that a watrant/check was originally issued. Warranticheck Number 13700744360 ee 03/06/2024 Reason for original issue of Warrant/Check (8): QO Payroll i For Services or Goods furnishedReimbursement_ O Other: Reimbursement 4/16/24 S:\PROCESSES\Warrants - Duplicate or Stale\o2 Forms\Schools\Schools-Warrants Check: Revised June 2015 April 15, 2024 To whom it may concern; lam writing this letter to explain the reason for my request for a reissue of a reimbursement check. On or around March 20" my original reimbursement check was destroyed, My husband mistook the envelope for one that was in the shred pile. Unfortunately, the check and page with the details were shredded. Please let me know if there are any questions. Thank you. Sincerely, At LMM Samantha Miller 4/16/24, 8 43 AM Warrant Status Print Attachments aa VMware Horizon Maintain New Status Setup Attachments | 3700744360 4 Warrant header General Posting Warrant number: 13700744360} Invoice: Holder: Invoice date: Issued date: 3/6/2024 12:00:00 am Paid date: Status: Stopped Positive pay sent date: 3/7/2024 12:00:25 pm Exception fl ‘ception flag: A detail Exception ae None Agency voucher number: 1074 Queued for positive pay: Agency claim number: Agency low orig: Locked for reconcile: Agency PO number: Registered Agency sub fund: Date registered: Agency dept num: No of days interest: 0 Annual interest rate: 0.00000 « Warrant Lines Oo Amount Payee Account 97.99 MILLER, SAMANTHA JO https //horizon maricopa gov/portal/webclient/#/desktop 1/1