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Maricopa County Human Resources Memo To: Fran McCarroll, Clerk of the Board CA) -J • C., From: Lisa Platek Date: July 26, 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 Lisa at x 6-3619 for any questions. Please route approved Affidavits back to County Payroll, Suite 220. Stale Dated Warrant (Over 1 Year) Duplicate Warrant Thank you. AFFIDAVIT/NOTICE OF CLAIM STATE OF ARIZONA COUNTY OF MARICOPA t BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on the 21" day of , 20 (7- , he/alpresented Ii to Maricopa County, for payment a claim for services rendered or supplies furnished during the month of June 2017 , said claim being in the sum of Four hundred seventy eight and 31/100 Dollars ($ 478.31 ) in payment of which the Board of Supervisors caused the Warrant No. _0022487856 to be issued on June 14 ,2017 , drawn on the Payroll Clearing Account fund. Affiant further says that although he/she was informed and believes that the above mentioned warrant was regularly issued, the same has never been received, or has been lost. Under penalty of perjury, affiant hereby affirms that this claim is correct and the amount shown is due and owing. WHEREFORE, affiant requests that the Board of Supervisors issue to him/her a duplicate of said Warrant No. _0022487856 In the sum of $ 478.31 Dated: 11z( , 20 ( r" .. Signed: Affiant IIf/ ***A $12.00 fee for the stop payment and reissuancZ of the warrhnt will be deducted from the replacement check.*** Notary LAVINIA Public - Sleg at S l geinCtib and sworn to before me this 2-14"day of 11.1-1 , 20 n My MARICOPA Commission COUNTY Expires • • April 14, 2021 CO-41(114./ Notary Public My commission expires: .1Ptpit 1(-4 2-024 T MON APPR(TVAL PLEASE MAIL REPT,ACF,MENT CHECK TO: