STAMPED & REDACTED - FOR AGENDA ATTACHMENT - SAMUEL GORDON.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: 03/05/2024

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

Fowler Dist #45 Gordon, Samuel 3700738279 $635.70

Date

Amount

Reissue WT #

Office of the Maricopa County

Schooi Superintendent

Contact Name: YVETTE ORTIZ

Warrant Void/Stop Request
District Name / Number: FOWLER ELEMENTARY #45

Attachments:

Original Warrant

UW | Lost Warrant Affidavit (required for ALL reissues)

Vendor Letter (if requesting Vendor reissue}

Warrant Number Warrant Date’) Amount. Payee i] a. 2
{starting with “37"} (mm/dd/yyyy) {os it appears in Check Manager) 2 & B

-o
3700738279] 2/20/2024 | $ 635.70 GORDON, SAMUEL v

Ol®
O

©|©
O}O

FILE.

District Approver: YWETTE ORTIZ A) ys
, \

ate: 2/28/2024

_ Notes: EMPLOYEE NEVER RECEIVED THE WARRANT THROUGH THE MAIL DUE TO INCORRECT ADDRESS ON

Por Internal Use Only
Clerk of Beard Date:

CU

i

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.

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

On or about 92/20/2024 (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 is due and owing, and the applicant requests that a replacement

Sone issued im/her in the sum of $635. Dd .(3)

Signed: Or~ (4)

(5) Subscribed and sworn to before me this ZA day of _feb 20224.

—_— Quart ole
NOTARY PUBLIC
My ea OG T expires: |
66/2026 Bresso eos 08-00-26 (seal)

Commission No. 635913

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

versnigiem ia” [3700738279

Original Date of Issue 19/90/2024

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

O For Services or Goods furnished
© Other:

3/7/24

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

3/5/24, 11:08 AM VMware Horizon
Warrant (f - mcto) - Warrant number: 3700738279, Stopped

axe | é '

fehl Warrant | Status | Print | Attachments

y
Maintain New Status | Setup | Attachments ae _ _
3700738279
4 Warrant header
General Posting
Warrant number; Invoice:
Holder: Invoice date:
issuect date: 2/20/2024 12:00:00 am Paid date:
Status: Stopped Positive pay sent date: 2/16/2024 09:00:05 am
Exception flag: Ii Agency details
Exception reason: None Agency voucher number: 30
Queuied 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

O Amount ; Payee Account

Iq ais & pl | we | pj | Identification of the warrant

htlps://horizon.maricapa.gov/portal/webelient/#/desktop 4A