011117 DUPLICATE WARRANTS 1_REDACTED.PDF

Maricopa County
Human Resources
Memo
To: Fran McCarroll, Clerk of the Board
From: Linda Widner
Date: December 7, 2016
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
Thank you.
Replacement Lost Warrant Form 1 02/25/2015
4

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/ Claim Form
This application is for: IDuplicate 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.
kct (1), being first sworn, upon oath deposes and says:
ameielaima
On or about t\tVeffiver 37)1 (tRdate)(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/ickleck be issu to him/ in the sum of $ I ) 020 00 .(3) (ctrus,r)
ideT#131,&11
nJ, - 'fay(
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 ubscribed and sworn to before me this 7-7-11-1 day of rireinvxl- 10 .
. 111q4 rri
OTARY PUBLIC
713
ril
My commission expires: SANDRA G. MASON CD a'
Nobly MARIcOPA Pubic - Stale COUNTY caritas Igseat-r-
My Cornmitslon ExplreaJune 14,2020 co
•I•••I
Warrant/Check Number bb2244 I -72-5 (1)
(if known) (6)
Original Date of Issue QNPM129.ir" 30 ) 101W
Of known) (7)
Reason for original issue of Warrant/Check (8): APPROVED DEC 0 8 2016
)Payroll
O For Services or Goods furnished
O Treasurer's refund/payment
O Other:
Revised April 2015 A.R.S. 11-632 ik 11-644

Maricopa County
Human Resources
Metro
c773
To: Fran McCarroll, Clerk of the Board
From: Wanda Childers
Date: December 7, 2016
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 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: Duplicate or EJ 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.
M I REYA GARCIA (1), being first sworn, upon oath deposes and says:
Name/claimant
On or about 11120 /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, 91 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 be issued to him/her in the sum of $125.00 -(3 )
4-zw..6()
Signed: ---)446.12.vo_ (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) Subscribe51 and sworn to before me this L..) day ofFS):IiiYeEC20 Lc.
PUBLIC
COLLEEN M. REDMOND
Notary Public - Slate of Arizona
mxpires: MARICOPA COUNTY
Lo My Commission Expires May 9, 2019
Warrant/Check Number 22437786
(if known) (6) LID
Original Date of Issue 11130/2016 TZt•
El known) (7) CD
ran
Reason for original issue of Warrant/Check (8): ti)
Ill Payroll
ILI For Services or Goods furnished
D Treasurer's refund/payment
El Other:
Revised April 2015 A.R.S. 11-632 Si. 11-644