STAMPED AND REDACTED - FOR AGENDA ATTACHMENT - SHAMROCK FOODS CO DAIRY DIVISION.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: 03/19/2024

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 Shamrock Foods Co Dairy Division _| 3700716050 $4,579.68

Date

Amount

' Relssue WT #

Office of the Maricopa County

School Superintendent

Finance Desk
ma 20201016

Warrant Void/Stop Request

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

Contes <i

Attachments:
CT Original Warrant
Lost Warrant Affidavit (required for ALL reissues)
Vendor Letter {if requesting Vendor reissue)

Warrant Number Warrant Date | Amount Payee

{staring with “37") {mm/dd/yyyy} {os it appeors in Check Manager}

Void
Stop

3700716050) 11/29/2023 | $4,579.68 | SHAMROCK FOODS CO DAIRY DIVISON

Notes: Check sent to wrong address

District Approver: [4 Vy Wh; Dote: 3/14/2024

For Internal Use Oraly
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.

Shamrock Foods Co Dairy Divison
Name/Claimant

On or about \\-an-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.

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

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

man be issued to him/her in the sum of $4,579.68 (3)

Signed? |-Qtuccae Yer 5 (4)

(5) Subscribed and sworn to before me this /4“~_day of Febrocrg 20.24

NOTARY/PUBLIE — #

My commission expires:

$13 -20R4 (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 13700716050 _
erent) —_|11/29/2023

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

i For Services or Goods furnishedDairy purchases for food service.
C Other; Dairy purchases for food service.

SAPROCESSES\ Warrants ~ Duplicate or Stale\02 Forms\Schools\Schools-\ 3 /1 9 / 24

Real Farm. Real Fresh.

March 19, 2024

To Whom It May Concern:

This {etter is to request to void check number 3700716050 and reissue a new one. In addition,
Patricia King, the person signing the affidavit, is an authorized representative of Shamrock Foods
Company — Dairy Division.

Kind Regards, }

Wark Malizer
Mark Meltzer
Credit Manager Dairy/Systems/National Accounts

3/15/24, 8:03 AM

Vatyi Warrant | Status | Print | Attachments

VMware Horizon

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Maintain New Status | Setup | Attachments

3700716050

4 Warrant header
General Pasting
Warrant number: Invoice:
Holder: invoice date:
Issued date: 11/29/2023 12:00:00 am Paid clate:
Status: Stepped Positive pay sent date: 11/30/2023 09:00:17 am
Exception flag: td Agency details
Exception reason: None Agency voucher number, 2443
Queued for positive pays | Agency claim number:

Agency low orig:

Locked forreconcile {| Agency PO number:
Registered Agency sub fund:
Date registered: Agency dept num:
No of days interest: 0

Annual interest rate: 0.00000

4 Warrant Lines

Oo Amount | Payee

4,579.68 SHAMROCK FOODS CO DAIRY DIVISON

| Account

[lq ad oc: Bm pl | ee | y | Identification of the warrant

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