STAMPED & REDACTED - FOR AGENDA ATTACHMENT - ADA CILLIS.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: 02/12/2024

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

Littleton Dist #65 Cillis, Ada 3700636124 $25.38

Amount Date

Relssue WT #

Office of the Maricopa County
Scheel Superintendent

Contact Name: ANGELICA SUAREZ

Warrant Void/Stop Request

District Name / Number: LITTLETON ELEM SCHOOL DISTRICT

Attachments:
| Original Worrant
Lost Warrant Affidavit (required for ALL reissues)
L] Vendor Letter (if requesting Vendor reissue)

Warrant Number Warrant Date | Amount Payee zs a.
{sorting with “37") {mm/dd /yyyy) (as i appecrs In Check Monager) 2 & g

&
3700636124|3/30/2023| $ 25.38 ADA CILLIS ©O

©O0OU

®©®OU0

©OU

Notes:

District Approver: Rlorny,

Date: 2 -S- Q4

For Internal Use Only
Clerk of Boord Date:

Void Report Date:

Schools Affidavit/ Claim Form

Application for a Duplicate Warrant/Check (definitions are on page 2)

STATE OF ARIZONA

COUNTY OF MARICOPA instruction sheet which is page 2 of this form.

ADA CILLIS
“™NamerClaimant

On or about

Note: Numbers on this form correspond to numbers on the

(1), being first sworn, upon oath deposes and says:
(date)(2) a warrant/check was issued to the

above named person/entity in the amount as stated below. Such warrant/check was
elther never received or was subsequently inadvertently lost or destroyed and there is
no reasonable probability of its belng 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 In the sum of $25: 8 (3)

signed: Mn C CLL. (4)

Osean Subscribed and swom to before me this 24. day of Febuary 2024.

NOTARY SQaun

commission expires:
Pobuant ol, 202

Fup

MARIA D. KRIEGER

Commission # 697013 (seal)

a” expires February 01, 2028

—S

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

artnet 3700636124
al all ass f issue 03/30/2023

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

O Payroll

C For Services or Goods furnished ,,RAVEL EXPENSE
Other: TRAVEL EXPENSE

S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools 2/13/2024

Revised June 2015

ESRC RS BLED SUNN UNIS BER ESO PN I NTBROSS FRSA ULMINE: cr ey
“SGHOOL EXPENSE WARRANT | 3700636124 :
TREASURER FA MARICOPA COUNTY — : ;
FHOEN! XK a EON). assure aeisero DATE ‘CONTAGL NO. :
yy sensi ; RRA fs el 03/30/2023 | . 65878715
 LY}TLETON ELEMENTARY SCHOOL DISTRICT #65
PAY nt WARRANT AMOUNT | &
**Twonty Five and 38/100" Dollars $26.38
' _ ‘ . VOID AFTER 365 DAYS s
TO ADA GILLIS AG \ i
THE — py , i
ORDER ‘steve
; F si SiS enartl BION,
OF Co uperivensonss AUTHORIZED SIGNATURES

PO , *

“93/30/2023 Check: ~ 65878745 —, EXPENSE”

MARICOPA COUNTY SCHOOLS ° ; PHOENIX, ARIZONA AP 20230330 3700836124
ADA CILLIS | |_ 03/30/2023 _| |
Payee f | | Check Date | 1
AccountNumber PONumber Invalce Amount
O 0210-0210 ow
a.
VOUCHER: 1067 TOTAL: $25.38

HARLANO CLARKE 22007 20120012

219/24, 2:40 PM VMware Horizon
Bl OR] Warrant (1 ~ mcto) - Warrant number; 3700636124, Stopped
- Al Warrant I.
i v=) j he| 8
n=] jae] 7 |
Vict Warrant | Status | Print | Attachments
Maintain New | Status | Setup | Attachments _

3700636124

“aWarantheder
General Posting
Warrant number: 3700636124} Invoice:
Holder: Invoice date:
issued date: 3/30/2023 12:00:00 am Paicl date:
Status: Stopped Positive pay sent date; 3/30/2023 09:00:06 am
Exception flag: |
f “?P ton ag | Agency details
Except £ons
acepmon feason None Agency voucher number: 1067
Queued for positive pay: || Agency claim number;

Agency low orig:
Locked forreconcile: | | Agency PO number:
Registered Agency sub fund:
Date registered: Agency dept nurn:
No of days interest: p) ;
Annual interest rate: 0.00000 ‘
4 Warrant Lines ~
o Amount Payee Account
25.38 ADA CILLIS
Modoc: > BI | ee | 9} | Identification of the warrant

https://horizon.maricopa.gov/portalAvebclient/#/desktop 4M

|
|
|
|
|
!
|