Extracted text (via pymupdf_layout)
2437 characters
30ARD 71Cn: Maricopa County Human Resources 2011 .)Lt I P.: :3j Memo To: Fran McCarroll, Clerk of the Board From: Debbie Upton Date: September 15, 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 M. 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: • 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. Clay Jones (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 9/6/ 17 (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/c kbe is to him/her in the sum of $ 1475.30 .(3) Signed: (4) Note: Please attkch' a copy of the warrant/check if available and/or any other evidence that a wArant/check was originally issued. CI) (5) Subscribed and sworn to before me this IS day of Sep-P-- 20)017. ilakitimi7kuz0 NOTARY PUBLIC EILEEN WILLIAMEPREAS Notary Public - Stale of Arizona My commission expire: MARICOPA COUNTY My November Commission 9, 2018 Expires (seal) Warrant/Check Number 0022508016 (if known) (6) Original Date of Issue 9-6-17 )>, (if known) (7) > ""•J rn Reason for original issue of Warrant/Check (8): 1$4J Payroll (xi LI For Services or Goods furnished r5.3 LI Treasurer's refund/payment LJ 111 Other: Revised April 2015 A.R.S. 11-632 & 11-644 CLERK, BOARD OF SUPERVISORS MARICOPA COUNTY