Extracted text (via pymupdf_layout)
2456 characters
IIARICOIAA Maricopa County 2016 0C1 3j PH 2: 54 Human Resources 004"-eki Ce\'' Memo) To: Fran McCarroll, Clerk of the Board From: Zellnor Bullis Date: October 31, 2018 Re: Replacement of Lost Payroll Warrants Please find attached 11 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: Election Stale Dated Warrant L Duplicate Warrant Thank you. Replacement Lost Warrant Form 1 02125/2015 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: VI Duplicate or El 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. Ahtanya Riggs (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 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 $ 265.88 .(3) Signed: Ctz-)hairi-cAo,.) (4) Note: Please aVach a c00% of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. -11 C1-3 (5) Subscrib,e Ifl rd sworn to before me this 7-20 day of ,1 C NOTARY PUBLIC COLLEEN M. REDMOND My commission expires: Notary Public - State of Arizona rommission MARICOPA Expires COUNTY May 9, 2022 Warrant/Check Number (if known) (6) 22604319 Original Date of Issue (if known) (7) September 19th, 2018 Reason for original issue of Warrant/Check (8): VI Payroll D For Services or Goods furnished 1613/1 DTreasurer's refund/payment El Other: Revised April 2015 A.R.S. 11-632 & 11-644