102517 DUPLICATE WARRANTS 3.PDF

'Maricopa County
Human Resources
Memo
To: Fran McCarroll, Clerk of the Board
From: Debbie Upton
Date: September 27, 2017
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 .plicate Warrant
RECEIVED
Thank you.
SEP 2 7 2017
MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS
Replacement Lost Warrant Form 1 02/25/2015

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: El 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.
eii 1,11,i-y I pi f (1), being first sworn, upon oath deposes and says:
'- arrieffLlairnan
On or about -"Z --/ 7 (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 ajni of .(3)
Signed: (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 (g-? / clay of &s,.-5t42,41..ki.t2/1,-- 20
h/1CL/rv
NOTARY PUBLIC
DIANNA LYNN MANZUTTO
Notary Pubilo•Stateof Arizona
My commission expires: MARICOPA COUNTY
v-rIo.A.c.-h 1 ao 1 °) My Commission Expires W07,201(1 (seal)
Warrant/Check Number
(if known) (6) Oo 221- // 33y
Original Date of Issue c'evao/2_,/ 7
(if known) (7)
A _
Reason for original issue of Warrant/Check (8): nAT,4 S ny,2 8 2017
El Payroll
CI For Services or Goods furnished.
El Treasurer's refund/payment
0 Other:
Revised April 2015 A.R.S. 11-632 & 11-644

Maricopa County
Human Resources
Memo
To: Fran McCarroll, Clerk of the Board
From: Linda Greinke
Date: September 27, 2017
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 Linda G. at ext. 63770 for any questions. Please route
approved Affidavits back to County Payroll, Suite 220.
Stale Dated Warrant Duplicate Warranl)
Thank you.
RECEIVED
SEP 27 2017
Replacement Lost Warrant Form CLERK MARICOPPOMEZZIW BOARD OF 8UPERVISORS
V61 •
&kl

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: 1g 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.
14414v 64.1 n TA_ (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 67/L-0 / z-0 / (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 /her in the sum of $ 36 8 '1 .(3)
Signed: (4)
Note: Please attaeh 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 -7 day of Sepi-entiliA 20 / 7.
ALEJANDRACERVANTES
Notaty Pubuc- Site of AliZOIta
M.ARICOPA COUNTY
My commission expires: My Common AO 2, 2020 Wires
(seal)
Warrant/Check Number
(if known) (6)
Original Date of Issue
(if known) (7)
Reason for original issue of Warrant/Check (8): DAT.
gl Payroll cat - CV° C04441/4?
111 For Services or Goods furnished CLERK, BOARD OF SUPERVISORS
CI Treasurer's refund/payment
1E1 Other:
Revised April 2015 A.R.S. 11-632 & 11-644
rs.
_

Maricopa County
Human Resources
Memo
To: Fran McCarroll, Clerk of the Board
From: Linda Greinke
Date: September 27, 2017
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 Linda G. at ext. 63770 for any questions. Please route
approved Affidavits back to County Payroll, Suite 220.
Stale Dated Warrant Duplicate Warrant-)
Thank you.
RECEIVED
SEP 27 2017
Replacement Lost Warrant Form 1 CLERK tvIARICOPAOZWAIV
BOARD OF SUPERVISORS

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: II 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.
Tenneh J Turner-Warren (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about September 20, 2017 kdateA2) v 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 thi' imdis c• 2 -ct
and the amount shown is due and owing, and the applicant requests trfit6 reVacerert
warrant/check be issued to hinn/pyr in the :Inn of $ 1,057.39 ---x— •-,-. --r Cr •(
ii I
./1 _.... ..... rn
Signed: •• C,
fso
Note: Please attach a copy of the warrant/check if available and/or agy other
evidence that a warrant/check was originally issued.
(5) Subscribed and sworn to before me this 9t(0 day of ,5 erot-- 20 I .
4_2 ,r1
NOTARY PUBLIC MATTIE SUE CORTHEN
Notary Public - Arizona I
My commission expires: My Comm. Maricopa Expires County Nov 29, 2019
A,10 v. 9, 1() Nor--•I•-•mr-"‘r-m (cc I)
Warrant/Check Number 9P61 C-2_6'27
(if known) (6)
Original Date of Issue —W---11 APPROVED
(if known) (7)
S28 2W
Reason for original issue of Warrant/Check (8): DATA lel —Iv— diete
El Payroll ajte,l/Li
ERK, BOARD OF SUPERVISORS
111 For Services or Goods furnished MARICOPA COUNTY
LI Treasurer's refund/payment
El Other:
Revised April 2015 A.R.S. 11-632 & 11-644