STAMPED & REDACTED - FOR AGENDA ATTACHMENT - VICTOR HUMPHREY.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: 02/21/2024

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

Queen Creek Dist #95 Humphrey, Victor 3700733962 $487.38

Date

Amount

Reissue WT #

Office of the Maricopa County

School Superintendent

Warrant Void/Stop Request

District Name / Number: QCUSD/95

Contact Name: Kathy Saxton

Finance Desk
mm 20201016

Attachments:

——--

Original Warrant

=|

‘caine?

YW | Lost Warrant Affidavit {required for ALL reissues)

Vendor Letter (if requesting Vendor reissue)

Warrant Number Warrant Date | Amount
(starting with “37") (mm/dd/yyyy)

Payee
{as it appears in Check Manager)

3700733962! 2/6/2024 | $ 487.38

Victor Humphrey

Notes: lost check

District Approver: ado

Date: fu CoH

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 rials = oartesupad to numbers on the
COUNTY OF MARICOPA Instruction sheet which is page 2 of this form.
VICTOR HUMPHREY he Fn
Ce (1), being first sworn, upon oath deposes and says:
On or about ob | lo| dod Y (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 Daf him/her in the sum of $ 487. B (3)

sworn to before me this LD day 0 g 0

(5) Subscribed a

NOTARY*PUBLIC
My commission expires: te 4):

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

meh: = gi 3700733962

ASSANDRA KENNEDY

Notary Public - State of Arizons
PINAL COUNTY

Commission # 629036

Original Date of Issue
. (if known) (7) 2/I6/2 024

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

For Services or Goods furnished
Other: : 2/22/2024

S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrar
Revised June 2015 A.R.S. 11-632 & 15-999

2/21/24, 1001 AM VMware Horizon
Warrant (1 - mcto) - Warrant number: 3700733962, Stopped

, KK v— hed G
y =| |
Warrant Status Print = Attachments
aa
Maintain New Status Setup Attachments
3700733962
4 Warrant header
General Posting
Warrant number: Invoice:
Holder: Invoice date:
Issued date: Paid date:
Status: Stopped Positive pay sent date:
Exception flag:
Exzepbon tenes mene Agency voucher number: 26
Queued for positive pay:

Agency claim number:

Agency low orig:
Locked for reconcile:

Agency PO number:
Registered Agency sub fund:
Date registered: Agency dept num:
No of days interest: 0
Annual interest rate: 0.00000
« Warrant Lines
Oo Amount Payee
487.38 HUMPHREY, VICTOR
Iq <4 > PL | A | © | identification of the warrant

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