STAMPED & REDACTED SABRINA YEGHIAZARIAN.PDF
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Maricopa County
Human Resources
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Av
Memo Of ee
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To: Cindy Goelz, Clerk of the Board 60:8
From: Debbie Upton
Date: May 13, 2021
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 Debbie U. at ext. 66329 for any questions. Please
route approved Affidavits back to County Payroll, Suite 400.
Stale Dated Warrant Duplicate Warrant
Thank you.
Replacement Lost Warrant Form 02/25/2015
Application for a Duplicate or Stale-Dated Warrant/ Check
Affidavit/ Claim Form
This application is for: (um Duplicate or L] 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.
Sabrina Yeghiazarian (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 09/12/2021 (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 $ 1440.98 (3)
4
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5 1 31 1 3 4 1414 2072 62 9 33.927425 Se
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4 1 43 1 2 0 403 2499 207 47 -1
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5 1 43 1 2 2 475 2499 135 47 50.516754 Payroll
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3 1 44 1 0 0 403 2585 1642 97 -1
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5 1 44 1 2 1 1767 2634 278 48 94.695976 05/14/2021
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4 1 47 1 1 0 328 2917 256 32 -1
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| Company: MC1 —=— ioe
Period End 05/02/2021 Reprint No
Pace tee
ADP Enterprise HR screen print as of: 05/12/2021 04:57 PM
Dept 4 Y00
[Dove lopment
Planning