Extracted text (via pymupdf_layout)
3315 characters
CLERK 30ARD HARICOPA OF SUPER COMO'? VISCUS Maricopa County Human Resources 261S AUG I Ail 11 1 8 ii err co Fran McCarroll, Clerk of the Board From: Debbie Upton Date: August 1, 2019 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 220. Stale Dated Warrant Duplicate 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: 12 ',Duplicate or 0 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. .1e._(1), being first sworn, upon oath deposes and says: ame aimant On or about ¶ILtt,1 (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 eck be is or o i her in the sum of S .(3) (4) Cite: Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. VI Subscribed and orn to before me this ____day of 1St 20 ADRIANA M. MORRIS Notary Public - State of Arizona My co misqion expires: My MARICOPA Commission COUNTY Expires December 18, 2021 (seal) t(1711.\- Warrant/Check Number (if known) (6) OCIS'a_20 Original Date of Issue (if known) (7) Reason for original issue of Warrant/Check (8): ri 2/Payroll AUG 0 1 2019 0 For Services or Goods furnished ter7 A."; OrTI: 1—nrSi*". , ' 0 Treasurer's refund/payment MARICOPA (1) Co El Other: Revised April 2015 A.R.S. 11-632 & 11 -644 - Webster Jr,John T Company: MC1 Off Cycle: Y MC1 - Maricopa County Pay Group: EXM Separate Check # 0 I 8006- Juvenile Court Period End 07/14/2019 Reprint: N EXM - Exempt EEs Page 101 Adjustment: N Terminated 07/13/2019 Reg/FT Line: 1 - Webster J John T - MC1/EXM CY-Earnings Taxes Deductions Garnishments [I Special Accumulators Distributions Name Webster Jr,John T Confirmed Check Checkt Issue Date Earnings Taxes Deductions Net Pay 2300856 07/15/2019 1,160.00 182.09 330.13 647.78 Regularand Overtime Earnings Taxes Reg Hours Reg Pa . OT Hours OT Pay FED SSDisMLvEE 68.16! 8.00 116.00 FED MedicareEE 15.94 40.00 580. 00 FED Withholdng 90.30 FED SS/Dis ER 68.16 FED MedicareER 15.94 - Other Earnings Deductions Code Hours Amounts Add to Gross 186 After-Tax 129.00 HOL 8.00 116.00 14 After-Tax 1.97 VAC 24.00 348.00 41 Before-Tax 39.95 50 Before-Tax 1.09 61 Before-Tax 19.62 ADP Enterprise HR screen print as of: 07/30/2019 09:46 AM