STAMPED & REDACTED - PATRICIA WENZEL.PDF

Maricopa County
Human Resources

phoe
(unt Ae
Memo ne vED

JAN 2 6 2023

To: Juantia Garza, Clerk of the Board micnen COUNTY
CLERK BOARD CF SUPERVISOR

|

From: Zell Bullis
Date: January 25, 2023

Re: Replacement of Lost Payroll Warrants

Please find attached _1 __ Affidavit/Notice of Claim(s) for lost

payroll 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.

Please call Zell Bullis at ext. 60409 for any questions. Please
route approved Affidavits back to County Payroll, 8" Floor.

Stale Dated Warrant Duplicate Warrant

“4
Thank you. or

Replacement Lost Warrant Form 1 08/02/2022

Cie

cates

Application for a Duplicate or Stale-Dated Warrant/Check

Affidavit/Claim Form

This application is for: Duplicate or | Stale-Dated (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.
Patricia Wenzel (1), being first sworn, upon oath deposes and says:
~~ Name/Claimant
On or about 11/23/2022 (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/enerk be issued hi him/her in the han (3)
Signed: Xe MA IN = (4)

/ —.

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

(5) Subscribed and sworn to before me this 2B "aay of Janda 20.2.4.

NOTARY E PUBLIC ” Sim ESMERALDA H. SPALDING
ae Notary Public - Arizona
My commission expires: on ee eis
03) 1) | vo) Expires August 30, 2025 (seal)
Warrant/Check Number
(if known) (6) 52487021
Original Date of Issue
(if known) (7) 11/23/2022
Reason for original issue of Warrant/Check (8):
Payroll
LIFor Services or Goods furnished
LItreasurer’s refund/payment
Clother:
1/27/2023

Revised April 2015

Maricopa County 301 W. Jefferson St. Suite 800 Phoenix, AZ 8500?
Patricia Wenzel
\Company : Employee 1D) aaa
Maricopa County I 40/31/2022

Check Datel Check Number
44/23/2022

Description Dates Hours Rate Amount_YTD Hours YTD Amount
\Central Board Workers 13 10/31/2022 - 11/13/2022 21.75 13 282.75 42.5 552.50}
Hazard Pay 41/07/2022 - 11/43/2022 15.75 1 15.75 30.5 30.50)
Eamings 298.50 583.00
Description Amount YTD
Federal Withholding - Taxable Wages 298.50 583.00}
State Tax Taxable Wages - AZ 298.50 583.00}

Marital Status
(Allowances,
\Additional Withholding

0.00%

ank Account Number USD Amount Amount
Check) 298.50 __ USD;

H
H