062117 DUPLICATE WARRANT - 3.PDF

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@, --anARD OF SURERNISSE > Maricopa County
|
Oe Human Resources
To: Fran McCarroll, Clerk of the Board
From: Debra Upton
Date: June 2, 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
warrani(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 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: CJ Duplicate or MY stale-Dated (definitions are on page 2)
STATE OF ARIZONA Note: Numbers on this form correspond to numbers cirthe “J
COUNTY OF MARICOPA Instruction sheet which is page 2 of this forme5 = e fe
Pail N oo 4 t -
HELEN WeNG (1), being first sworn, upon oath depesés anu say!
Name/Claimant mo ra
On or about [| se-2ei (date)(2) a warrant/check wasaigsue to
above named person/entity in the amount as stated below. Such waitant/chéck S
either never received or was subsequently inadvertently lost or destroyed anddhere 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
| ‘ro 29
warrant/check be issued to him/her in the sum of $ (3)
Signed: [A bon \_ 8 (4)
sa
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 2. day of June 2011.
NOTARY PUBLIC
EILEEN WILLIAMS-PF
a
ission expi OSPACOUNTY
M y commission expires:
WN--d01% My ormmer 2018 (seal)
|
Warrant/Check Number ee a a ae
(if known) (6)
Original Date of Issue l- enw 3e- 20° 56 IG
(if known) (7)
Reason for original issue of Warrant/Check (8):
Ol Payroll
O For Services or Goods furnished
1 Treasurer’s refund/payment
(1 Other:
C:\Users\williamse\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\HTTDL74G\Warrants Checks notice
of claim.doc
Revised April 2015 A.R.S. 11-632 & 11-644

BOARD OF SUE Maricopa County
Human Resources
re
Viemo
To: Fran McCarroll, Clerk of the Board
From: Debbie Milliron
Date: June 2, 2017
Re: Replacement of Lost Payroll Warrants
Please find attached _3 __ 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. 62406 for any questions. Please
route approved Affidavits back to County Payroll, Suite 220.
)
Stale Dated Warrant (_ Duplicate Warrant
_
oo a a an
= ee
Thank you.35
O «= Sa
i co at
“Replacement:0st Warrant Form 1 02/25/2015

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: Duplicate or [_] 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.
Eduardo Navarro Gurrola (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 9/18/2017 (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
803.97
warrant/check be issued to him/her in the sum of $ (3)
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 \ day of ye Nee 20_|*7.
NOTARY PUBLIC NOTARY PUBLIC, ARIZONA
MARICOPA COUNTY ae SS
My commission expires: CT nee see Le =
Nov % Dov Gen
n » ng
Warrant/Check Number Oe
70000759
(if known) (6) D> on
Original Date of Issue =5 lf
co
Reason for original issue of Warrant/Check (8):
j=] Payroll
C1 For Services or Goods furnished
(11 Treasurer's refund/payment
C1) Other:
Revised April 2015 A.R.S. 11-632 & 11-644

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: Duplicate or LJ 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.
Eduardo Navarro Gurrola (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 9/18/2017 (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
292.31
warrant/check be issued to him/her in the sum of ¢ (3)
Signed: Ele trv) VOU aa Od (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) sworn to before me this |” day of oat 20 dol]
aalls
\ Oa rs
RANMIR
NOTARY PUBLIC (_j NOTARY PUBLIC, ARIZONA
MARICOPA COUNTY
My Commission Expires
My commission expires: November 9, 2020
rou % Bot
Warrant/Check Number
10000758
(if known) (6)
Original Date of Issue
9/17/2017
(if known) (7)
Reason for original issue of Warrant/Check (8):
j=] Payroll
C1 For Services or Goods furnished
LJ Treasurer's refund/payment
(1 Other:
a
JUNO'7 2017
Revised ced April Apr 2015 A.R.S. 11-632 & 11-644
Ay NL
FALE bw SUPERVISORS
wieert MARICOPA AA 0 COUN! JNTY

Application for a Duplicate or Stale-Dated Warrant/ Check
Affidavit/Claim Form
This application is for: Duplicate or L] 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.
Eduardo Navarro Gurrola (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 9/18/2017 (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
935.22
warrant/check be issued to him/her in the sum of $ (3)
Signed: A, ety Untwe~ (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 \° day of lo ie a 20 V1.
ANNA MARIE RAMIREZ
PUBLIC a VOTARY PUBLIC, ARIZONA
NOTARY /) MARICOPA
te COUNTY ~~
My Commission Expires cored = “<j
My commission expires: ovember 9, 2020 2
Nov % 4o0aO ca =o = (sealp
=
~~ i mM)
Warrant/Check Number ri P=
Original Date of Issue 25 2°? ©
Reason for original issue of Warrant/Check (8):
fm Payroll
L] For Services or Goods furnished
L] Treasurer’s refund/payment
L] Other:
Revised April 2015 A.R.S. 11-632 & 11-644