072016 DUPLICATE WARRANTS 12 - HR_REDACTED.PDF

BOARD ADD OF OF Wh SHPERYISOR'S SUPERYWISOK be EN N 5 Maricopa County
MADICODA jo. \Y raAIy mig Yv
Human Resources
2016 JUL 13 PH 2:08
H.©. oat .
Memo
To: Fran McCarroll, Clerk of the Board
From: Wanda Childers
Date: July 13, 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

TOPAYROL” F/\S
RECEIVED
iy a9
Application for a Duplicate or Stale-Dated Warlarit/Check
ft
Affidavit/Claim Form PAY
This application is for: Duplicate or C 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.
Anita Jean Lawson (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 9/01/2016 (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 pe issued to him/her inthe sum of $ 105.00 s(3)
(s
sow LAD (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 before me this YD + day of \ yy Lk 20\ la
sworn
Lo
NOTARY PUBLIC LH
SUSAN PONCE
ows ite Meibeng
My commission expires:
[Warrant/Check Number
Original Date of Issue
6/01/2016
(if known) (7)
Reason for original issue of Warrant/Check (8):
Payroll
1 For Services or Goods furnished
L] Treasurer's refund/payment
1 Other:
Revised April 2015 A.R.S. 11-632 & 11-644