Extracted text (via pymupdf_layout)
2406 characters
il,t1Al tIARIcoo, • O Gt) Maricopa County tOlt OCT 3 Ii 2: 5t Human Resources Memo To: To: Fran McCarroll, Clerk of the Board From: Zellnor Bullis Date: October 31, 2018 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 B. at ext. 60409 for any questions. Please route approved Affidavits back to County Payroll, Suite 220. Acct/Fund: 100D2102120ELEC1000 P21047 Dept: 2120— Election Cycle Stale Dated 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: Duplicate or LI 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. Kaitlin Ward )1tAn-LIN ALEKA4311.04 11"1"243 (1), being first sworn, upon oath deposes and says: Name/Claimant On or about September 19th, 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 -clairivis cect and the amount shown is due and owing, and the applicant requests tha la rerijac4nt t,J warrant/check be issued to him/her in the sum of $ 502.15 C Signed: Note: Please attach a copy of the warrant/check if available aftd/or aay other evidence that a warrant/check was originally issued. (5) Subçcribed and sworn e me this 21•1 day of ue-COC342- 20 IMMO- NOTARY PUBL faZ7% -7 1. > My commission expires: • • -C- 0 1,11 2.026 (seal) Warrant/Check Number (if known) (6) 22603583 Original Date of Issue (if known) (7) September 19th, 2018 Reason for original issue of Warrant/Check (8): AP 1.""'NV'ED Payroll 0/ 19,0(1 ( 0 For Services or Goods furnished 0Treasurer's refund/payment 0 Other: Revised April 2015 A.R.S. 11-632 8( 11-644