STAMPED & REDACTED - PATRICIA FITZGERALD.PDF
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BOARD OF SUPERVISE? MARICOPA Maricopa County Human Resources 9023 JAN 30 PA 2:0: ond) Det: +07 Memo ~— To: Juantia Garza, Clerk of the Board From: Zell Bullis Date: January 30, 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 &> i Thank you. Replacement Lost Warrant Form 1 08/02/2022 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: Duplicate or L] state-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 Fitzgerald (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/check be issued to him/her in the sum of $_449:50 (3) Sioned een On Tepe (4) Note: Please attach 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 23 day of Dan sort 20.22. NOTARY PUBLIC My commission expires: Co. 10641084 \r(4) eee Expires 12/91/2036 (seal) Warrant/Check Number (if known) (6) 52485182 Original Date of Issue (if known) (7) 41/23/2022 Reason for original issue of Warrant/Check (8): Payroll (For Services or Goods furnished LItreasurer’s refund/payment [Aother: Nevee Received - 1/31/2023 Revised April 2015 Maricopa County Human Resources Payroll & Employee Records Division 301 West Jefferson Street Suite 220 Phoenix, AZ 85003-2143 DATE: January 30, 2023 Phone: 602-506-3519 Payroll Fax: 602-372-0277 Records Fax: 602-506-5509 TO: Jessica Kiles “wamernees FROM: Zell Bullis RE: Stop Payment on Warrant Please place a stop payment on the Warrant listed below. It has been determined that the Warrant is outstanding as of this date: Warrant Number: 52485182 Issue Date: 11/23/2022 Payable to: Patricia Fitzgerald Amount: $449.50 Reason for Stop Payment: Employee didn’t receive Payroll check in the mail. Attach a print screen of the paycheck view. Belluon Bullis Authorized Signature — Payroll Specialist Date Stopped Stopped by Transaction Number Time Stopped Maricopa County 301 W. Jefferson St. Suite 800 Phoenix, AZ 85003 Patricia Fitzgerald played 1D]. Pay Period Begin fin: Rayer 11/43/2022) shack Datel 14/23/2022 State Tax Taxable Wages - AZ ates Hours Rate Amount_YTD Hours YTD Amount Central Board Workers 13 40/31/2022 - 11/13/2022 32,75 13 425.75 32.75 425.75) Hazard Pay 44/07/2022 - 11/13/2022 23.75 4 23.75 23,76 23.75} Earnings 449.50 449.50) Amaunt |Federal Withholding - Taxable Wages 449.50 449.50 449.50 449.50 Marital Status, Allowances Additional Withholding Account Name USD Amount Amount 449,50 USD} (Check)