STAMPED & REDACTED JOSELUISE G. ARBALLO.PDF
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Maricopa County Human Resources 7 o 1202 BWW NH a + To: Fran McCarroll, Clerk of the Board Wd :2 From: Zell Bullis BG Date: March4, 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 Zell Bullis at ext. 60409 for any questions. Please route approved Affidavits back to County Payroll, Suite 220. Stale Dated Warrant uplicate Warrant 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 (_] 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. Joseluise G Arballo (1), being first sworn, upon oath deposes and says: Name/Claimant On or about February 2, 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 $528.74 (3) DAL” Artie” (4) Signed: Note: Please attach a copy of the warrant/check if available and/or any other My commission expires: | \a\ Notary Public - Maricopa County Y.[U, /G) Commission No. 591883 ve Aer cae’ «My Commission Expiros Warrant/Check Number 2301998 (if known) (6) Original Date of Issue (if known) (7) 02/02/2021 Reason for original issue of Warrant/Check (8): Payroll C] For Services or Goods furnished [_Itreasurer’s refund/payment 03/04/2021 . [_Jother: “Revised April 2015 a Ee - Arballo, Joseluis G | MC1- - Maricopa County 2140 - Early vee Services | NEX-NonExempt ; Terminated 5 1 8 1 1 2 579 305 231 105 21.355600 “o1/g0(2021 5 1 8 1 1 3 835 309 168 129 37.849075 TemolPT 5 1 8 1 1 4 1025 335 103 80 13.493986 oo 2 1 9 0 0 0 1310 62 359 132 -1 3 1 9 1 0 0 1310 56 359 138 -1 4 1 9 1 1 0 1385 62 277 67 -1 5 1 9 1 1 1 1385 62 179 67 95.233124 Company: 5 1 9 1 1 2 1584 75 78 35 81.505142 MC1 4 1 9 1 2 0 1310 141 359 53 -1 5 1 9 1 2 1 1310 170 2 2 17.016973 _ 5 1 9 1 2 2 1348 142 212 52 75.377747 PayGroup: 5 1 9 1 2 3 1585 141 84 35 91.531906 NEX 2 1 10 0 0 0 1465 275 228 115 -1 3 1 10 1 0 0 1465 275 228 115 -1 4 1 10 1 1 0 1465 275 228 56 -1 5 1 10 1 1 1 1465 276 100 55 91.563271 Page: 5 1 10 1 1 2 1606 275 87 47 73.133759 226 4 1 10 1 2 0 1484 337 188 53 -1 5 1 10 1 2 1 1484 337 104 53 56.055893 Line. 5 1 10 1 2 2 1651 341 21 34 75.051605 2 2 1 11 0 0 0 1304 84 4 302 -1 3 1 11 1 0 0 1304 84 4 302 -1 4 1 11 1 1 0 1304 84 4 302 -1 5 1 11 1 1 1 1304 84 4 302 95.000000 2 1 12 0 0 0 1558 339 940 53 -1 3 1 12 1 0 0 1558 339 940 53 -1 4 1 12 1 1 0 1558 339 940 53 -1 5 1 12 1 1 1 1558 339 940 53 95.000000 2 1 13 0 0 0 1274 125 1080 135 -1 3 1 13 1 0 0 1274 125 1080 135 -1 4 1 13 1 1 0 1274 125 1080 71 -1 5 1 13 1 1 1 1274 182 2 2 34.964699 ; 5 1 13 1 1 2 1747 192 2 2 28.813725 ; 5 1 13 1 1 3 1937 143 8 32 0.000000 _ 5 1 13 1 1 4 1982 135 163 61 94.485008 Separate 5 1 13 1 1 5 2161 138 116 51 92.527496 Check 5 1 13 1 1 6 2287 125 33 48 92.527496 # 5 1 13 1 1 7 2333 138 21 36 96.886574 0 4 1 13 1 2 0 1310 206 477 54 -1 5 1 13 1 2 1 1310 208 173 52 56.520672 Period 5 1 13 1 2 2 1495 207 68 52 96.762482 End 5 1 13 1 2 3 1584 206 203 37 96.722137 02/07/2021 2 1 14 0 0 0 2131 71 228 50 -1 3 1 14 1 0 0 2131 71 228 50 -1 4 1 14 1 1 0 2131 71 228 50 -1 5 1 14 1 1 1 2131 72 55 35 96.296257 Off 5 1 14 1 1 2 2201 72 113 49 92.399872 Cycle: 5 1 14 1 1 3 2332 71 27 35 92.373734 Y 2 1 15 0 0 0 2096 197 364 126 -1 3 1 15 1 0 0 2096 197 364 126 -1 4 1 15 1 1 0 2096 197 364 65 -1 5 1 15 1 1 1 2096 204 218 58 28.953823 Reprint 5 1 15 1 1 2 2434 241 26 10 34.775833 No 4 1 15 1 2 0 2098 265 262 58 -1 5 1 15 1 2 1 2098 265 216 58 93.268959 Adjustment: 5 1 15 1 2 2 2335 271 25 35 93.223686 N 2 1 16 0 0 0 43 412 2450 20 -1 3 1 16 1 0 0 43 412 2450 20 -1 4 1 16 1 1 0 43 412 2450 20 -1 5 1 16 1 1 1 43 412 2450 20 95.000000 2 1 17 0 0 0 41 54 8 478 -1 3 1 17 1 0 0 41 54 8 478 -1 4 1 17 1 1 0 41 54 8 478 -1 5 1 17 1 1 1 41 54 8 478 95.000000 2 1 18 0 0 0 50 619 2443 18 -1 3 1 18 1 0 0 50 619 2443 18 -1 4 1 18 1 1 0 50 619 2443 18 -1 5 1 18 1 1 1 50 619 2443 18 95.000000 2 1 19 0 0 0 38 392 2460 292 -1 3 1 19 1 0 0 38 392 2460 292 -1 4 1 19 1 1 0 38 392 2460 292 -1 5 1 19 1 1 1 38 392 2460 292 95.000000 2 1 20 0 0 0 98 665 2304 15 -1 3 1 20 1 0 0 98 665 2304 15 -1 4 1 20 1 1 0 98 665 2304 15 -1 5 1 20 1 1 1 98 665 2304 15 95.000000 2 1 21 0 0 0 38 684 2460 73 -1 3 1 21 1 0 0 38 684 2460 73 -1 4 1 21 1 1 0 38 684 2460 73 -1 5 1 21 1 1 1 38 684 2460 73 95.000000 2 1 22 0 0 0 128 670 597 126 -1 3 1 22 1 0 0 128 670 597 126 -1 4 1 22 1 1 0 128 670 597 126 -1 5 1 22 1 1 1 128 670 139 110 56.309532 “Name 5 1 22 1 1 2 260 670 93 126 50.467834 i 5 1 22 1 1 3 387 683 184 99 52.104588 o,Joselus 5 1 22 1 1 4 596 689 19 54 76.362419 G 5 1 22 1 1 5 655 718 28 44 0.000000 - 5 1 22 1 1 6 713 682 12 32 59.326294 : 2 1 23 0 0 0 1133 675 266 84 -1 3 1 23 1 0 0 1133 675 316 84 -1 4 1 23 1 1 0 1133 675 266 84 -1 5 1 23 1 1 1 1133 680 42 54 0.000000 S 5 1 23 1 1 2 1193 675 206 84 46.685596 Confirmed 2 1 24 0 0 0 38 686 1166 261 -1 3 1 24 1 0 0 38 686 1166 261 -1 4 1 24 1 1 0 38 686 1166 261 -1 5 1 24 1 1 1 38 686 1166 261 95.000000 2 1 25 0 0 0 470 778 666 141 -1 3 1 25 1 0 0 470 778 666 152 -1 4 1 25 1 1 0 489 778 565 85 -1 5 1 25 1 1 1 489 787 98 62 92.918633 Issue 5 1 25 1 1 2 599 803 94 55 65.052750 Date 5 1 25 1 1 3 753 778 48 76 0.000000 S 5 1 25 1 1 4 852 799 20 56 0.000000 - 5 1 25 1 1 5 893 779 161 84 42.912682 Earnings 4 1 25 1 2 0 470 862 666 57 -1 5 1 25 1 2 1 439 864 266 75 31.645517 02/02/2021 5 1 25 1 2 2 902 862 234 57 33.077473 680.00 2 1 26 0 0 0 1390 686 187 71 -1 3 1 26 1 0 0 1390 686 187 71 -1 4 1 26 1 1 0 1390 686 187 71 -1 5 1 26 1 1 1 1390 686 187 71 95.000000 2 1 27 0 0 0 1313 777 278 153 -1 3 1 27 1 0 0 1313 777 306 133 -1 4 1 27 1 1 0 1313 777 278 79 -1 5 1 27 1 1 1 1313 777 152 68 0.000000 Taxes 5 1 27 1 1 2 1589 854 2 2 31.301813 2 4 1 27 1 2 0 1452 868 107 62 -1 5 1 27 1 2 1 1452 868 107 62 58.489834 68.17 2 1 28 0 0 0 1716 768 260 136 -1 3 1 28 1 0 0 1716 768 260 136 -1 4 1 28 1 1 0 1716 768 234 85 -1 5 1 28 1 1 1 1716 768 218 85 36.495529 ‘Deductions 5 1 28 1 1 2 1948 802 2 2 20.173038 ; 4 1 28 1 2 0 1876 862 100 42 -1 5 1 28 1 2 1 1876 862 100 42 96.883026 83.09 2 1 29 0 0 0 2125 753 285 159 -1 3 1 29 1 0 0 2125 753 285 159 -1 4 1 29 1 1 0 2125 753 225 104 -1 5 1 29 1 1 1 2125 797 38 24 0.000000 o 5 1 29 1 1 2 2182 753 61 104 95.726677 Net 5 1 29 1 1 3 2257 794 93 56 65.250412 Pay 4 1 29 1 2 0 2249 867 161 45 -1 5 1 29 1 2 1 2249 867 124 45 92.774498 528.74 5 1 29 1 2 2 2406 872 4 39 94.683708 | 2 1 30 0 0 0 2397 665 6 284 -1 3 1 30 1 0 0 2397 665 6 284 -1 4 1 30 1 1 0 2397 665 6 284 -1 5 1 30 1 1 1 2397 665 6 284 95.000000 2 1 31 0 0 0 98 933 2309 25 -1 3 1 31 1 0 0 98 933 2309 25 -1 4 1 31 1 1 0 98 933 2309 25 -1 5 1 31 1 1 1 98 933 2309 25 95.000000 2 1 32 0 0 0 98 948 635 10 -1 3 1 32 1 0 0 98 948 635 10 -1 4 1 32 1 1 0 98 948 635 10 -1 5 1 32 1 1 1 98 948 635 10 95.000000 2 1 33 0 0 0 54 947 76 65 -1 3 1 33 1 0 0 54 947 76 65 -1 4 1 33 1 1 0 54 947 76 65 -1 5 1 33 1 1 1 54 947 76 65 95.000000 2 1 34 0 0 0 1201 948 304 7 -1 3 1 34 1 0 0 1201 948 304 7 -1 4 1 34 1 1 0 1201 948 304 7 -1 5 1 34 1 1 1 1201 948 304 7 95.000000 2 1 35 0 0 0 685 971 508 15 -1 3 1 35 1 0 0 685 971 508 15 -1 4 1 35 1 1 0 685 971 508 15 -1 5 1 35 1 1 1 685 971 508 15 95.000000 2 1 36 0 0 0 42 54 6 1003 -1 3 1 36 1 0 0 42 54 6 1003 -1 4 1 36 1 1 0 42 54 6 1003 -1 5 1 36 1 1 1 42 54 6 1003 95.000000 2 1 37 0 0 0 60 916 697 133 -1 3 1 37 1 0 0 60 916 697 133 -1 4 1 37 1 1 0 60 916 697 133 -1 5 1 37 1 1 1 60 951 24 70 0.000000 : 5 1 37 1 1 2 95 1012 15 15 17.229328 ji 5 1 37 1 1 3 130 916 249 111 0.000000 ceardo 5 1 37 1 1 4 352 942 169 94 93.065567 Overtime 5 1 37 1 1 5 526 945 159 104 85.225327 Earnings 5 1 37 1 1 6 721 956 36 40 68.441711 — 2 1 38 0 0 0 88 1056 45 44 -1 3 1 38 1 0 0 88 1056 45 44 -1 4 1 38 1 1 0 88 1056 45 44 -1 5 1 38 1 1 1 88 1056 45 44 95.000000 2 1 39 0 0 0 685 947 483 65 -1 3 1 39 1 0 0 685 947 483 65 -1 4 1 39 1 1 0 685 947 483 65 -1 5 1 39 1 1 1 685 947 483 65 95.000000 2 1 40 0 0 0 126 1080 1044 17 -1 3 1 40 1 0 0 126 1080 1044 17 -1 4 1 40 1 1 0 126 1080 1044 17 -1 5 1 40 1 1 1 126 1080 1044 17 95.000000 2 1 41 0 0 0 147 1101 501 81 -1 3 1 41 1 0 0 147 1101 501 81 -1 4 1 41 1 1 0 147 1101 501 81 -1 5 1 41 1 1 1 147 1101 263 81 55.847717 4000 5 1 41 1 1 2 390 1107 264 90 20.402040 680,00 2 1 42 0 0 0 44 1014 1152 105 -1 3 1 42 1 0 0 44 1014 1152 105 -1 4 1 42 1 1 0 44 1014 1152 105 -1 5 1 42 1 1 1 44 1027 74 60 51.365505 |. 5 1 42 1 1 2 133 1035 199 51 84.226463 RegHours 5 1 42 1 1 3 398 1022 100 97 85.297096 Reg 5 1 42 1 1 4 503 1039 63 66 78.904320 Pay 5 1 42 1 1 5 587 1055 17 30 8.550625 — 5 1 42 1 1 6 672 1014 172 94 58.394188 OTHours 5 1 42 1 1 7 898 1015 48 38 0.000000 S 5 1 42 1 1 8 973 1031 133 51 92.044510 OTPay 5 1 42 1 1 9 1194 1032 2 2 86.296860 | 2 1 43 0 0 0 88 1419 1106 11 -1 3 1 43 1 0 0 88 1419 1106 11 -1 4 1 43 1 1 0 88 1419 1106 11 -1 5 1 43 1 1 1 88 1419 1106 11 95.000000 2 1 44 0 0 0 364 1459 830 8 -1 3 1 44 1 0 0 364 1459 830 8 -1 4 1 44 1 1 0 364 1459 830 8 -1 5 1 44 1 1 1 364 1459 830 8 95.000000 2 1 45 0 0 0 104 1415 497 127 -1 3 1 45 1 0 0 104 1415 497 127 -1 4 1 45 1 1 0 104 1415 497 127 -1 5 1 45 1 1 1 104 1415 298 127 39.518105 -OherEaings 5 1 45 1 1 2 406 1432 195 47 19.866657 a 2 1 46 0 0 0 132 1477 1051 107 -1 3 1 46 1 0 0 132 1477 1051 107 -1 4 1 46 1 1 0 132 1477 1051 107 -1 5 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931 172 142 -1 4 1 58 1 1 0 1335 931 135 92 -1 5 1 58 1 1 1 1335 931 135 92 0.000000 “Taxes 4 1 58 1 2 0 1429 1020 78 73 -1 5 1 58 1 2 1 1429 1020 78 73 81.201012 FED 2 1 59 0 0 0 1223 980 109 61 -1 3 1 59 1 0 0 1223 980 109 61 -1 4 1 59 1 1 0 1223 980 109 61 -1 5 1 59 1 1 1 1223 980 109 61 95.000000 2 1 60 0 0 0 1224 1052 9 308 -1 3 1 60 1 0 0 1224 1052 9 308 -1 4 1 60 1 1 0 1224 1052 9 308 -1 5 1 60 1 1 1 1224 1052 9 308 95.000000 2 1 61 0 0 0 1279 1052 7 308 -1 3 1 61 1 0 0 1279 1052 7 308 -1 4 1 61 1 1 0 1279 1052 7 308 -1 5 1 61 1 1 1 1279 1052 7 308 95.000000 2 1 62 0 0 0 1702 1002 304 53 -1 3 1 62 1 0 0 1702 1002 304 53 -1 4 1 62 1 1 0 1702 1002 304 53 -1 5 1 62 1 1 1 1702 1012 261 43 45.400124 ‘SSDisMLVEE 5 1 62 1 1 2 1988 1002 18 10 0.000000 _ 2 1 63 0 0 0 1714 1083 255 73 -1 3 1 63 1 0 0 1714 1083 255 73 -1 4 1 63 1 1 0 1714 1083 255 73 -1 5 1 63 1 1 1 1714 1083 229 73 87.345680 MedicareEE 5 1 63 1 1 2 1950 1093 19 33 0.000000 . 2 1 64 0 0 0 1648 1163 293 241 -1 3 1 64 1 0 0 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1 2489 1701 8 458 95.000000 2 1 82 0 0 0 46 2153 2450 17 -1 3 1 82 1 0 0 46 2153 2450 17 -1 4 1 82 1 1 0 46 2153 2450 17 -1 5 1 82 1 1 1 46 2153 2450 17 95.000000 2 1 83 0 0 0 46 2308 1882 79 -1 3 1 83 1 0 0 46 2308 1882 79 -1 4 1 83 1 1 0 46 2308 1882 79 -1 5 1 83 1 1 1 46 2318 139 55 96.371574 ADP 5 1 83 1 1 2 212 2316 327 71 96.381165 Enterprise 5 1 83 1 1 3 565 2315 92 56 96.347084 HR 5 1 83 1 1 4 677 2328 214 43 95.796707 screen 5 1 83 1 1 5 919 2314 145 70 95.796707 print 5 1 83 1 1 6 1085 2326 69 43 96.968651 as 5 1 83 1 1 7 1179 2311 77 57 96.714218 of: 5 1 83 1 1 8 1284 2310 324 57 95.920570 03/01/2021 5 1 83 1 1 9 1640 2309 169 57 95.920570 01:46 5 1 83 1 1 10 1836 2308 92 56 96.418503 PM 2 1 84 0 0 0 2531 2 19 3282 -1 3 1 84 1 0 0 2531 2 19 3282 -1 4 1 84 1 1 0 2531 2 19 3282 -1 5 1 84 1 1 1 2531 2 19 3282 95.000000