STAMPED & REDACTED - ALFRED OXTON.PDF

Maricopa County
Human Resources

Memo CH HANDDelover|

To: Juantia Garza, Clerk of the Board

From: Zell Bullis
Date: January 13, 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

CS
Thank you. oe

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 O 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.

Alfred Oxton (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 $_823-50 (3)

Signed: x4 Oye (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) wa A and sworn DL” Ve andr me this ge day of Airs 2420 BF
onli ae .
Notary Public State of Arizona
3 Mari
My commission expires: D) Cheryt Marie Motysa
CAE eid wecmmumegmaazers § (6.
Warrant/Check Number
(if known) (6) 52487038
Original Date of Issue
(if known) (7) 11/23/2022

]

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

Cror Services or Goods furnished
L_Ttreasurer’s refund/payment

Revised April 2015

Maricopa County Phoenix, AZ 85003

Current 323.50
[YTD 685.50}

e se
Description Dates Hours Rate Amount YTD Hours YTD Amount}
|Central Board Workers 13 40/31/2022 - 11/13/2022 23.75, 13 308.75 50.25 653.25]
Hazard Pay 11/07/2022 - 11/13/2022 14.75 i 14.75 32.25 32.25)
Eamings 323.50 685.50
[Description Amount YTD
[Federal Withholding - Taxable Wages 323.50 685.50}
State Tax Taxable Wages - AZ 323.50 685.50}

farital Status, Single or Married filing separately}
[Allowances 0} 0.00%,
[Additional Withholding 0} 0}
2 Payment Informatio!
Bank Account Name Account Number USD Amount Amount

(Check) 323.50__USD}

Payroll & Employee
Records Division

301 West Jefferson Street
Suite 220

Phoenix, AZ 85003-2143
Phone: 602-506-3519
Payroll Fax: 602-372-0277
Records Fax: 602-506-5509
www.maricopa.gov

Maricopa County

Human Resources

DATE: January 13, 2023

TO: Jessica Kiles
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: 52487038
Issue Date: 11/23/2022
Payable to: Alfred Oxton
Amount: $323.50

Reason for Stop Payment: Employee didn’t receive Payroll check in the mail.

Attach a print screen of the paycheck view.

Gellwor Bullis

Authorized Signature — Payroll Specialist

Date Stopped Stopped by

Transaction Number Time Stopped