STAMPED & REDACTED DEBORAH EPPERSON-JOHNSON.PDF

Maricopa County
Human Resources
To: Fran McCarroll, Clerk of the Board
From: Debbie Upton
Date: April 6, 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 _ at x 6-6329 for any questions. Please
route approved Affidavits back to County Payroll, Suite 220. ¢4®
Stale Dated Warrant (Over 1 Year) Duplicate Warrant
Thank you.

Application for a Duplicate or Stale-Dated Warrant/ Check
Affidavit/ Claim Form
This application is for: i 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 lnstrustion sheet which is page 2 of this form.
al
tan Zp PevSon — (1), being first sworn, upon oath deposes and says:
“~Name/Claimant N a. ONnsSO”n
On or about B-\V-OU| (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
BKS.SO
warrant/check be issued to him/her in the sum of $ __.(3)
Dado de Re ~% Opp overs Tg Aun > (4)
Signed
Note. Please attach a copy of the warrant/check hook IF available and/or other
any
evidence that a warrant/check was originally issued.
(5) Subscribed-and sworn to before me this LS day of Viaven 20 2.\ .
Onauies
PITS
NOTARY PUBLIC
VANESSA CHAVEZ
Notary Public - Stete of Arizona
MARICGPA COUNTY
My commission expires: Commission # 567233
WW A 2.024 Expires June 9, 2023 : (seal)
Warrant/Check ve Number i | Aq, oO
inown) 6) OOD, Zo AAO me
Original Date of Issue
(if known) (7) >-\ \-
5	1	43	1	1	6	1303	2366	101	67	0.000000	pEvy
5	1	43	1	1	7	1409	2366	45	67	0.000000	ma
2	1	44	0	0	0	913	2222	6	208	-1	
3	1	44	1	0	0	913	2222	6	208	-1	
4	1	44	1	1	0	913	2222	6	208	-1	
5	1	44	1	1	1	913	2222	6	208	95.000000	 
2	1	45	0	0	0	316	2411	1936	28	-1	
3	1	45	1	0	0	316	2411	1936	28	-1	
4	1	45	1	1	0	316	2411	1936	28	-1	
5	1	45	1	1	1	316	2411	1936	28	95.000000	 
2	1	46	0	0	0	343	2486	994	111	-1	
3	1	46	1	0	0	343	2486	994	111	-1	
4	1	46	1	1	0	343	2486	994	51	-1	
5	1	46	1	1	1	343	2494	150	36	96.480148	Reason
5	1	46	1	1	2	511	2491	59	38	96.608871	for
5	1	46	1	1	3	586	2490	149	47	96.909187	original
5	1	46	1	1	4	757	2491	101	36	96.676559	issue
5	1	46	1	1	5	876	2489	41	38	93.293991	of
5	1	46	1	1	6	931	2486	318	47	92.620445	Warrant/Check
5	1	46	1	1	7	1266	2486	71	47	95.687004	(8):
4	1	46	1	2	0	413	2543	211	54	-1	
5	1	46	1	2	1	413	2543	60	52	0.000000	)
5	1	46	1	2	2	489	2549	135	48	95.410645	Payroll
2	1	47	0	0	0	416	2633	741	42	-1	
3	1	47	1	0	0	416	2633	741	42	-1	
4	1	47	1	1	0	416	2633	741	42	-1	
5	1	47	1	1	1	416	2639	36	36	27.298794	C1]
5	1	47	1	1	2	489	2638	66	37	96.648399	For
5	1	47	1	1	3	571	2638	170	36	96.212250	Services
5	1	47	1	1	4	760	2646	41	27	96.864288	or
5	1	47	1	1	5	817	2635	129	37	96.361717	Goods
5	1	47	1	1	6	963	2633	194	39	95.935684	furnished
2	1	48	0	0	0	1090	2757	330	8	-1	
3	1	48	1	0	0	1090	2757	330	8	-1	
4	1	48	1	1	0	1090	2757	330	8	-1	
5	1	48	1	1	1	1090	2757	330	8	95.000000	 
2	1	49	0	0	0	417	2712	1705	137	-1	
3	1	49	1	0	0	417	2712	1705	137	-1	
4	1	49	1	1	0	417	2712	1705	61	-1	
5	1	49	1	1	1	417	2726	35	36	10.082378	C
5	1	49	1	1	2	484	2719	237	42	0.000000	Treasurer's
5	1	49	1	1	3	739	2721	337	47	92.123344	refund/payment
5	1	49	1	1	4	1577	2771	2	2	89.635506	|
5	1	49	1	1	5	1840	2712	282	44	95.267845	04/06/2021
4	1	49	1	2	0	417	2785	1420	64	-1	
5	1	49	1	2	1	417	2813	35	36	48.150970	C1
5	1	49	1	2	2	487	2811	130	38	96.242172	Other:
5	1	49	1	2	3	1820	2785	17	8	0.000000	:
2	1	50	0	0	0	637	2843	783	13	-1	
3	1	50	1	0	0	637	2843	783	13	-1	
4	1	50	1	1	0	637	2843	783	13	-1	
5	1	50	1	1	1	637	2843	783	13	95.000000	 
2	1	51	0	0	0	343	2968	259	32	-1	
3	1	51	1	0	0	343	2968	259	32	-1	
4	1	51	1	1	0	343	2968	259	32	-1	
5	1	51	1	1	1	343	2969	104	26	96.601486	Revised
5	1	51	1	1	2	460	2968	61	32	96.414528	April
5	1	51	1	1	3	535	2969	67	25	96.855286	2015
2	1	52	0	0	0	2249	1708	36	713	-1	
3	1	52	1	0	0	2249	1708	36	713	-1	
4	1	52	1	1	0	2249	1708	36	713	-1	
5	1	52	1	1	1	2249	1708	36	713	95.000000	 
2	1	53	0	0	0	2517	14	33	3280	-1	
3	1	53	1	0	0	2517	14	33	3280	-1	
4	1	53	1	1	0	2517	14	33	3280	-1	
5	1	53	1	1	1	2517	14	33	3280	95.000000

Distributions
Name Epperson-Johnson,Deborah A Confirmed Check and Advice
_
Check# Issue Date Earnings Taxes Deductions Net Pay
23049909 03/17/2021 1,440.32 221.56 325.26 893.50
Check/Advice# Type Account# Amount
3287107 Checking 7003051567 70.00
Transit#: 256074974
23049909 Issue Check 823.50
Transit#:
ADP Enterprise HR screen print as of: 04/06/2021 08:47 AM