STAMPED & REDACTED - CPR SOLUTIONS.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: 12/23/2022

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
. Approved Affidavits may be routed back to the
Superintendent of Schools - Finance Desk at 4041 N. Central Ave #1200.

via e-mail at

(Option 1) or

Thank you
District Payee Warrant # Amount
Litchfield Elem Dist #79 _| CPR Solutions 3700564614 $390.50

Amount

Reissue WT #

Office of the Maricopa County

§chool Superintendent

Finance Desk
mun 20201016

Warrant Void/Stop Request

District Name / Number: o74
Contact Name: Beverly Martel |

Contact e-mail:

Attachments:
| Original Warrant
[HO ‘ost Warrant Affidavit (required for ALL reissues)
[e}Vender Letter (if requesting Vendor reissue)

Warrant Number | Warrant Date | Amount
{starting with "37") (enm/dd/yyyy)

Payee .
(os It appears in Chock Manager)

Void
Stop

BT OAH IY |O&/0OV/a024, 3 O00

[e] Re-issue

CER Solutrens ©O

©OU

@OD

©O0

Notes:

Oheck Last in mai|-

District Approver: Worely )@ualle

pleas re Issue

Date: 1Q[p.1[POR>

For Internal Use Only

Clerk of Board Date: Vold Report Date:

Schools Affidavit/Claim Form

Application for a Duplicate Warrant/Chact (actnitions ar

CPR SOLUTIONS (1), being first sworn, upon oath deposes and says:
Namercrmant—————— .

On or about 08/09/2022 (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

© 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,
and the amount shown is due and owi

® ON paga 2) |

STATE OF ARIZONA Note: Numbara ‘on this form correspond to numbers on the |
COUNTY OF MARICOPA Instruction sheat which Is page 2 of this form. . |
H

i

clalmant hereby affirms that this claim is correct
ing, and the applicant requests that a replacement

a in be Issued to him/her In the sum of $390.50
Signed.

(3)

(4)

3700564614/79748604
08/09/2029

12/28/2022

S'\PROCESSE: Ww, 7
Revised Jams aM ‘ varants * Duplicate or Stale\o2 Forms\Schools\

CPR

SOLUTIONS |

BASIC LIFE SUPPORT | FIRST AID | HEARTSAVER | ACLS | PALS

December 23, 2022

This letter serves to confirm that Tommye Jordan is the President/CEO of CPR
Solutions and as such is authorized to sign any and all documents for any reason. I
authorize re-issue of warrant number 3700564614

We may be reached at 623.640.3591 with any further questions.

Thank you.

> Survrise Arizana 85378 6

Warrant (1 - mcto) - Warrant number: 3700564614, Stopped

Warrant | Status Print Attachments

[oy |
| |

New | Status. Setup | Attachments

Maintain
3700564614
4 Warrant header ; 7
General Posting
Warrant number: S70D564614 Invoice:
Holder: Invoice date:
Issued date: 8/9/2022 12:00:00 am Paid date:
Status: Stopped Positive pay sent date: 8/10/2022 09:00:06 am
ion flag: im
weve ag Agency details
xcept ei Hy i
ceplton reason None Agency voucher number: 5816
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

4 Warrant Lines

O Amount Payee Account
390,50 CPR SOLUTIONS

Iq 4 bm | | al | Identification of the warrant

4/1