STAMPED & REDACTED - FOR AGENDA ATTACHMENT - DAVID CHASE.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: 04/17/2024

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

Agua Fria UHSD #216 Chase, David 3700751919 $133.91

Office of the Maricopa County
School Superintendent

Contact Name: NICOLE JACINTO

District Neme / Number: AGUA FRIA UNION HIGH SCHOOL

Contact e-i

Finance Desk
vom 20201016

Warrant Void/Stop Request

Attachments:

Original Warrant
[| Lost Warrant Affidavit {required for ALL reissues}

| Vendor Letter (if requesting Vendor reissue)

Amount

‘Warrant Number 2°) Warrant Date *)
(starting With"°37")- {mnimi/dd/yyyy)”

4/9/2024

$ 133.91

CHASE,DAVID

3700751919

© OU

®©®OU

Amount

OO

District Approver:

Notes: Chase, David lost this check. Please void this check and re-issue

Date:

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.
Chase, David

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

Name/Claimant

On or about O4 /o9] OF | 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 fs due and owing, and the applicant requests that a replacement

watrant/check peissued to him/her in the sum of $133.91 (3)
—_ 8
Signed: Coke G CA (4)

NOTARY PUBLIC

Sarah A Moreno
Notary Publi
Marlcopa County, Anzona.

My commission expires; My Comm. Expires 08-11-27
Ss ) Z) fe , lag Sr Commission No, 651517 (seal)

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

Neenfeaan. (8700751919

os (rman @)_|04/09/2024

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

For Services or Goods furnished
O Other:

4/17/24

S:\PROCESSES\Warrants - Dupiicate or Stale\02 Forms\Schools\Sct
Revised June 2015

4117/24, 8:31 AM

Warrant (1 - mcto) - Warrant number: 3700751919, Stopped

VMware Horizon

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3700751919

"a Warrant header
General Posting
Warrant number: 3700751919) Invoice:
Holder: Invoice date:
Issued dates Paid date:
Status: Stopped Positive pay sent date:
Exception flag: Ld Agency details
Exception reasom None Agency voucher number: 38
Queued for positive pay: | | Agency claim number:
Agency low orig:

Locked forreconcite: | | Agency PO number:
Registered Agency sub fund:
Date registered; Agency dept nur:
No of days interest: 0
Annual interest rate: 0.00000

4 Warrant Lines
ia Amount | Payee : Account

133.91 CHASE, DAVID

Iq dob: em Pl | ao | % | Identification of the warrant

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