STAMPED & REDACTED - FOR AGENDA ATTACHMENT - AMPARO REYES.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: 04/01/2024

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 Reyes, Amparo 3700723819 $106.00

Amount Date

Reissue WT #

Office of the Maricopa County

School Superintendent

Contact Name: Gerri-Ann Whigham

Finance Desk
mm 20201016

Warrant Void/Stop Request

District Name / Number: Nadaburg Unified School District #81

Attachments:
[| Original Warrant
Lost Warrant Affidavit (required for ALL reissues}
Vendor Letter (if requesting Vendor reissue)

Warrant Number Warrant Date |,Amouni ° Payee ; ne) 2 g
{starting with “37") (mm/dd/yyyy) {as it appears in Check Manager) 2 Fi Bz
£

'3700723819| 12/20/2023 | $ 106.00 | Amparo Reyes OO

Oxe]m

@©O0

@OU

Notes: Check was lost

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District Approver: Au ypaby

Date: A -; -2Z qd

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.

Amparo Reyes (1), being first sworn, upon oath deposes and says:
Name/Claimant

On or about 12/20/2023 (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 i him/her in the sum of $106.00 3)

Signed: a i ar, - (4)

—S

= =]
(5) Subscribed and sworn to before me this_20” day of Wgren 20 94%.

Notary Pua
. ay mt. re: 16s
ly commission expires: aaa eealitarnes are OP

saroieees— 5714/0 DCo _ (seal)

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

Maran fone (3700723819
Original Pate of Issue 12 /2 0 12023

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

C1 For Services or Goods furnished Reimbursement
m= Other: Reimbursement

4/02/24

S:\PROCESSES\Warrants ~ Duplicate or Stale\02 Forms\Schoo!s\Schools-Warrants Checks notice of claim.doc
Revised June 2015 A.R.S. 11-632 & 15-999