021517 DUPLICATE WARRANTS 5_REDACTED.PDF

Maricopa County
Human Resources
Memo
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T© Fran McCarroll, Clerk of the Board fs.= c=73 —r
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FVOGIAN Wanda Childers 1I3 Cr, -;?. —rj •
IDOM2 January 26, 2017
cr
Rc Replacement of Lost Payroll Warrants t.r.)
Please find attached 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 Wanda at ext. 60409 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: 0 Duplicate or MStale-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.
Catherine Parker-Williams (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about Q-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/checiqe to/h1 ,t32sum of $ / 94, Liz .(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 befor9 me this ,Z.3 day of 20/
.07irev erni6"/
My cpmm)ssion expires:
5/15/ 19 (seal)
Warrant/Check Number 22413414
(if known) (6)
Original Date of Issue 9-7-16
(if known) (7)
Reason for original issue of Warrant/Check (8):
• Payroll
O For Services or Goods furnished
O Treasurer's refund/payment
CLERK. BOARD u SUPERVISORS
O Other: MARICORA COUNTY
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