STAMPED & REDACTED - FOR AGENDA ATTACHMENT - JESSICA LOMELI.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: 04/04/2024

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

Wickenburg Dist #9 Lomeli, Jessica 3700647848 $150.00

Office of the Maricopa County Finance Desk

School Superintendent mm 20201016

Date

Amount

Reissue WT #

Warrant Void/Stop Request

District Name / Number: WICKENBURG UNIFIED SCHOOL DIS; Attachments:
Contact Name: LISA SMITH

Original Warrant

Lost Warrant Affidavit (required for ALL reissues)

Vendor Letter (if requesting Vendor reissue)

Warrant Number Warrant Date | Amount Payee ie} a2 ©
(starting with “37") (mm/dd/yy) (as it appears in Check Manager) 2 FS E:
3700647848) 5/8/2024 |$ 150.00 LOMELI, JESSICA ©O
©O
| ©O
©®O
Notes:

CHECK WAS LOST, PLEASE VOID

4
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District Approver: /~ wv) al; YA th
ie

roe 4/9/04

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.
Lomeli, Jessica (1), being first sworn, upon oath deposes and says:
~N amecr amar
On or about YU | 4 | 2t 24 (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 issued to him/her j, the sum of $ 150.00 .(3)
Signed: (4)
(5) Subscribed and sworn to before me this ark day of Apri \ 20 24.
NOTARY PUBLIC (Sree Notary Public - Arizona

ec)

Maricopa County
My Commission Expires
8 08/23/20

My commission Past 2027 Commesion # 655685

(seal)

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

| Warrant/Check Number” | 3700647848 / 9619780 _

| Original Date of Issue 05/08/2023

Cif known) 7,

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

im For Services or Goods furnished
O Other;

S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\School
Revised June 2015

4/4/24, 10 00 AM

el Warrant (1 - mcto) - Warrant number: 3700647848, Stopped

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Warrant Status Print Attachments
7.
Maintain New Status Setup Attachments
3700647848
« Warrant header
General Posting
Warrant number: Invoice:
Holder: Invoice date:
Issued date: 5/8/2023 12:00:00 am Paid date:
Status: Stopped Positive pay sent date: 5/9/2023
Exception flag: Agency details
Exception reason: None Agency voucher number:

Queued for positive pay:

Locked for reconcile:

Agency claim number:
Agency low orig:
Agency PO number:
Agency sub fund:

Registered Aaency dept num:
Date registered:
No of days interest: 0
Annual interest rate: 0.000(
4 Warrant Lines

CT Amount Payee
150.00 LOMELI, JESSICA

Account

Ke << Pm PL | 4 | © | Identification of the warrant

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