STAMPED & REDACTED - FOR AGENDA ATTACHMENT - RANDALL THORN.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: 02/23/2024

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 Thorn, Randall 3700719472 $60.29

Office of the Maricopa County
School Superintendent

Finance Desk
mm 20201016

Warrant Void/Stop Request

District Name / Number: QCUSD/95

Contact Name: JoannaBrewer

— FP

Attachments:

C

iginal Werront

Lost Warrant Affidavit (required for ALL reissues)

Vendor Letter (if requesting Vendor reissue}

3700719472) 12/7/2023 | $ 60.29 Thorn,Randall O®
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Notes: Reissue 004 “de my Remy hit ean

For Internal Use-Onby 4 WA

Clerk of Board Date: 9 ~~

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.
ahom Rawal (1), being first sworn, upon oath deposes and says:

On or about 7 202 (date)(2) a watrant/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/ch ven (Oeed issued y a, in the sum of $60. 29 -(3)

(4)

(5) Sub “1. Gay of 126 _ 2024,
i and s' before me this AA day of VAL,
WS erp perc met y

NOTARYPUBLIC ‘~~

My commission expires: MARICOPA COUNTY
4, 202) Enplies Augueto, 2024 (seal)

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

errant ene. {3700719472
Orginal row [12/07/2023

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

Cl For Services or Goods furnished'eimbursement for goods purchased
fl Other: reimbursement for goods purchased

2/23/24

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

2123/24, 7:57 AM VMware Horizon

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Warrant | Status | Print | Attachments

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Maintain lL. New | Status | Setup | Attachments
3700719472
4 Warrant header — : :
General Posting
Wartant number: 3700719472} invoice:
Holder: Invoice date:
(ssued date: 42/7/2023 12:69:00 arn Paid date:
Status: Stopped Positive pay sent date: 12/8/2023 09:09:45 am
Besption flag: id Agency details
jt 607%;
xeeption rea on None Agency voucher number: 7119
Queused for positive pays |:/| Agency claim number
Agency low orig:

Locked forreconcile; {| | Agency PO number
Registered Agency sub fund:
Date registerecl Agency dept nun:
No of days interest: 0
Annual interest rate: 0.00000

Sa eT a - ——
im) Amount Payee > Account ;

lq @ 3: & Bl | we | 0) | Identification of the warrant

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