020117 DUPLICATE WARRANTS 1_REDACTED.PDF

Maricopa County
Human Resources
Memo
To: Fran McCarroll, Clerk of the Board
From: Linda Widner
Date: January 4, 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 W. at ext. 68051 for any questions. Please
route approved Affidavits back to County Payroll, Suite 220.
Stale Dated Warrant Duplicate Warrant
Thank you.
Replacement Lost Warrant Form 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.
Angela Phillips (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 12/28/2016 (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/chec (11 be issued to him/her in the sum of $ 1579.12 (3)
±athIe
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 3 day of 3 °LAE\ 20 11 .
ed,wval.) caLSZAN0
NOTARY PUBLIC
IEEEN WILLIAM3PREAS
My commission expires: Notary MARICOPA Public • Mate COUNTY of Artbaba
I My November Correnletkm 9, 17491rits 2018 (seal)
Warrant/Check Number 781 1
(if known) (6) 4-('-04-
Original Date of Issue 1A-g8-
(if known) (7)
(3
Reason for original issue of Warrant/Check (8):
*I Payroll APPROVED c*?
0 For Services or Goods furnished JA 4 2017 .C" (xi
111 Treasurer's refund/payment
Revised April 2015 A.R.S. 11-632 & 11-644

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Memo
To: Fran McCarroll, Clerk of the Board
From: Linda Widner
Date: January 3, 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 W. at ext. 68051 for any questions. Please
route approved Affidavits back to County Payroll, Suite 220.
Stale Dated Warrant Duplicate Warrap nt
Thank you.
Replacement Lost Warrant Form 02/25/2015

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: E 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.
(1), being first sworn, upon oath deposes and says:
ame/CIaimant
On or about / (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 b ued to him/ r in the sum 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 3 day of 3a-in 20 17.
qittut-ti.MIA:ctnw ?wiz
NOTARY PUBLIC
My commission expires:
. 01 -2.0 IS seal)
Warrant/Check Number LA LA -4G-ce —4
(if known) (6)
Original Date of Issue
(if known) (7)
—C)
Reason for original issue of Warrant/Check (8):
0 Payroll
f\PPROVED
0 For Services or Goods furnished
DAT
0 Treasurer's refund/payment
0 Other: 1,471,eCe_A-0.-1
MArilGORA COUNf
Revised April 2015 A.R.S. 11-632 & 11-644

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