011117 DUPLICATE WARRANTS 5_REDACTED.PDF

Maricopa County
Human Resources
Memo
To: Fran McCarroll, Clerk of the Board 0
nO
From: Debbie Upton
Date: December 19, 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 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: RI Duplicate or El 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.
Amanda L Wyble (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 12/14 /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/check be issued to him/ er in the sum of $906.69 .( 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 day of be-C-- 2001_ 0 .
LEttge/M—KL144,
NOTARY PUBLIC EFLEENTILTIMIMMEW
Notary Public - State oikizena
1 MARI COPA COUNTY
My commission expires: My Commission Expire-9
November 9, 2018 (seal)
CV)-°Ig
Warrant/Check Number Da_4(44 -7911
(if known) (6)
Original Date of Issue ftp CT)
(if known) (7)
TT, C"")
Reason for original issue of Warrant/Check (8):
Payroll LC)
APPROVED (7'1 33.
E For Services or Goods furnished DAT flFi 9 7016 u:D
El Treasurer's refund/payment rn C—)
CI Other: ROARD cic SUFI LTV SO IS
C: \Users \williamse \AppData \Local \Mixosoft\Windows\Temporary Internet Files\Content.Outlook\HTTOL74GWVarrants Checks notice
of ciaim.doc
Revised AprIl 2015 A.R.S. 11-632 & 11-644

Maricopa County
Human Resources
Memo
To: Fran McCarroll, Clerk of the Board
From: Wanda Childers
Date: December 19, 2016
Re: Replacement of Lost Payroll Warrants
Please find attached 2 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
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: .1 Duplicate or El 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.
Danielle Hernandez Ochoa (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about November 30, 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/check be issued to him/her in the sum of $ 215.00 .(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 snorn to before me this 'day of Aga). 20/fr
NOTARY PUBLIC
GLORIAJ. NICHOLS
My cpnnmission expires: Notary NIARICOPA Public - State COUNTY of Arizona
02<3 hd -2D/8 My Comrnisin,. PPIP (seal)
Warrant/Check Number 22438887
(if known) (6)
Original Date of Issue 11/30/2016
(if known) (7)
Reason for original issue of Warrant/Check (8):
Payroll
APPROVED
El For Services or Goods furnishedl
DATE_ DEC
111 Treasurer's refund/payment
CI 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 E 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.
Elisabeth Hanley Denaro (1), being first sworn, upon oath deposes and says:
Name/Clamant
On or about November 30, 2016 r kdate)(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, g 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
warrantichediebje issued/ to him/11er in the sum of $ 140.00 .( 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 a day of liatilatiet 20
GLORIA. NICHOLS
MA commission expires: trotutPubib . State of AdzorkI
-7/E3 02d3 I Myearinilislon ICOPA Expires CoOINTY Feb. 23, 2018( eal)
Warrant/Check Number 22441528
(if known) (6)
Original Date of Issue 11/30/2016
(if known) (7)
Reason for original issue of Warrant/Check (8):
Payroll
I APPROVED
El For Services or Goods furnishedl
CATE. DEN 0 2016
1=1 Treasurer's refund/payment
1=1 Other: - • ,T7P991SORS- f
Revised April 2015 A.R.S. 11-632 6. 11-644