110216 DUPLICATE WARRANTS 3_REDACTED.PDF

Maricopa County
Human Resources
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Memo .ft:: Z )1 ,--.0 ....--' LP
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To: Fran McCarroll, Clerk of the Board ••••••
From: Debra Upton
Date: October 18, 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 Debra 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: g 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.
BETTY ELAINE WILDER (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 0941/2016 (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 aftc.r . the OPta of
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
vv arrant/check be issued to him/her in the sum of $ 140.00 4 3 )
Signed: 1"-sicit— Ct2_ .„ (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 t ore me this day of 13.= 7-1-1i0c 1-- 20 .
NOTARY PUBLIC MICHAEL TAGLE
NotaryPoWic - State of Arizona
My commis ion eKpires: My MARICOPA Comm I salon COuNrv Expires
(I (fd,OAO September 14, 2020 (seal)
Warrant/Check Number
(if known) (6)
Original Date of Issue 0941 /2016
(if known) (7)
Reason for for original issue of Warrant/Check (8):
El Payroll
111 For Services or Goods furnished
111 Treasurer's refund/payment
El Other:
Revised April 2015 A.R.S. 11-&32& 11-644

Maricopa County
Human Resources
Memo to
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To: Fran McCarroll, Clerk of the Board co '71 cn c
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From: Debra Upton •••-'
Date: October 18, 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 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: 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.
MYRNA I. MORALES (I), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 094.1/2016 (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 arid owing, and the applicant requests that a replacement
warrant/check be issued to him/her in the sum of $ 165.00 .(3)
Signed: LOJ 4Loutiag) (4)
Note: PltJase 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 b'ef-- 20 /(-) .
NOTARY PUBLIC Ilira.aboamaiIAmiamilli"."16"a1
STEPHEN BOND
Notary Public - Arizona
My commission expiras: Maficopa County
Cn (2`(' 42061 My Comm. Expires Aug 24, 2018 0 (seal)
Warrant/Check Number 22420d97
(if known) (6)
Original Date of Issue 094:1/2016
(if known) (7)
Reason for original issue of Warrant/Check (8): koPROVED _
Payroll '
DAT OCM 82016
1=1 For Services or Goods furnished
1=1 Treasurer's refund/payment
1=1 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: g Duplicate or U 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.
IRMA SALCIDO ROMERO (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 0941/2016 (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 $ 190.00 43)
Signed: P776eAA___ Jo /4'1-4 (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) Subscripfd and sworn to before m9 this LI day of cr.A--6\oes- 20
NOTA
cfrIxhic,36 COLLEEN M. REDMOND
mmiscsinnp3iLetsg : Notary Public- State of ArizOne
My Commission MARICOPA Expires COUNTY May 9, 2919 (seal)
Warrant/Check Number 22420317
(if known) (6)
Original Date of Issue 094,1 /2016
(if known) (7)
Reason for original issue of Warrant/Check (8): , C
Payrol l co - i
APPROVED
El For Services or Goods furnished 4;1 -
%
I=1 Treasurer's refund/payment -rm YOWPIrl ' •'1." - ts') 0
El Other: -0
Revised April 2015 A.R.S. 11-632 & 11-644