Extracted text (via pymupdf_layout)
3088 characters
• c 0 1.11-4 I Maricopa County Human Resources 2019 1-1A1 -6 All 2: 2 vvy Oletr(c To: Fran McCarroll, Clerk of the Board From: Zellnor Bullis Date: May 3, 2019 nv, 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 Zelinor B. at ext. 60409 for any questions. Please route approved Affidavits back to County Payroll, Suite 220. ACCT/FUND: 100D2102120ELEC10000 P21047 Dept: 2120 lections ale Dated Wa V1/11Hrii-Hiir 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: 0 Duplicate or g 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. Barbara A Bartlett (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 10/03/2018 (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 $ 121.00 .(3) Signed: 6/V.4"?)6A-AA` (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/)\ Subscribed and sworn to before me this 3 day of nA941 2011. LD Lika Dido — NOTARY PUBLIC EILEEN WILLIAMS-PREAS Notary Public • State of Arizona My commission expires: MARICOPA Commisslen #564340 COWIN Expires Novertitor 0, 2022 (seal) Warrant/Check Number , 22607227 (if known) (6) Original Date of Issue 10/03/2018 (if known) (7) Reason for original issue of Warrant/Check (8): • Payroll El For Services or Goods furnished 111 Treasurer's refund/payment LI Other: Revised April 2015 A.R.S. 11-632 & 11-644 - Bartlett,Barbara Ann Company: MC1 Off Cycle: N MC1 - Mancopa County Pay Group: ELE Separate Check # 0 2120- Election Cycle Period End 09/23/2018 Reprint: N ELE - Elections Page 167 Adjustment: N Active 11/04/2008 Temp/PT Line: 4 Bartlett,Barbara Ann - MC1/ELE ( Paycheck View CY-Earnings Taxes Deductions Garnishments Special Accumulators Distributions Name Bartlett,Barbara Ann Confirmed Check Checkt Issue Date Earnings Taxes Deductions Net Pay 22607227 10/03/2018 121 00 121.00 i. Regularand Overtime Earnings Reg Hours Reg Pay OT Hours Deductions Amounts Add to Gross ADP Enterprise HR screen print as of: 05/03/2019 10:28 AM