STAMPED & REDACTED - BARBARA ANN BARTLETT.PDF

Maricopa County
Human Resources

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To: Juanita Garza, Clerk of the Board NOV ; 1 9029
From: Lisa Platek CLERK BOAR SPERAIGeR 1S
Date: November 1, 2022

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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 Lisa P at ext. 63619 for any questions. Please route
approved Affidavits back to County Payroll, Suite 800.

Stale Dated Warrant ~ Duplicate Warrant }
if

__- :

Thank you.

Replacement Lost Warrant Form 1 02/25/2015

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 corraspond to numbers on the
COUNTY OF MARICOPA Instruction sheet which Is page 2 of this form.
Barbara Ann Barllett (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about 08/17/2022 (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 recelved 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 $318.50 (3)

Signed: Baglare Baprro-kt (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 qt day of. November 20.22.

a
ZL. SIZ
7 MARLYNDA LEE
Notery Public + State of Arizona
MARICOPA COUNTY
Gommmisalon # 676078
Expires February 4, 2024

NOTARY PUBLIC

My commission expires:
Feb. 44 20a4

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er a0 ee ven ta err a
Warrant/Check Number
(If known) (6) 23153963

Original Date of Issue
(if known) (7) 08/17/2022

Reason for original issue of Warrant/Check (8):
[Y] Payroll

(JFor Services or Goods furnished
CI treasurer's refund/payment
other: wee! See :

Revised April 2015

1/12/2023

#32 SmartCompliance ee Ge Me) Undated 10/2/2022

Home Processes

Management & Reversals

Look up the details of a single payment or range of payments by using the form below.
NOTE: The maximum check range is limited to 50 checks per request.

BRANCH COMPANY CODE : CHECK NUMBER

L_ Range of Check Numbers
8
[E] range of Dates
SORT BY: SA‘ ~ PAY STATUS: ALL » Q
Bartlett Barbara B F23 «# 23153953 tie # XXXXXX1745
$316.50 Issued on 08/17/2022 StoppediVeld as of 17002022