062216 DUPLICATE WARRANTS - 1_REDACTED - HR.PDF

Maricopa County
- Human Resources
Memo
To: Fran McCarroll, Clerk of the Board
From: Wanda Childers
Date: May 25, 2016 CD -.J
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: El 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.
Tarango-Solis, Karina (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 5/18/2016 (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 $ 784.91 .(3)
Signed :i_ (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 asiti day of MP)/ 20 )6.
4 4
NOTARY PUBLIC
AMY M. ECHOLS
My commission expires: Notary MARICOPA Public State COUNTY of Arizona
ATOVC1440eC 94' My November Commission 24, Expires 2018 (seal)
Warrant/Check Number 22381798
(if known) (6)
Original Date of Issue 5/18/2016 t
(if known) (7)
Reason for original issue of Warrant/Check (8): Crt
Payroll
El For Services or Goods furnished
El Treasurer's refund/payment
El Other:
Revised April 2015 A.R.S. 11-632 & 11-644
RK, BOARD OF SUPERVISORS
MARICOPA COUNTY

CLERK OF THE COURT
SUPERIOR COURT OF ARIZONA
MARICOPA COUNTY (602) 506-3676
Michael K. Jeanes Downtown Justice Center Fax - (602) 506-7684
Clerk 620 W, Jackson, Suite 3052 TDD —(602) 506-3211
Phoenix, Arizona 85003
May 25, 2016
TO: Maricopa County Payroll
FROM: Clerk of Court Human Resources / KarMa Tarango-Solis
Re: Lost Paycheck
The paycheck dated 05/18/2016 did not arrive in the mail and therefore was
not received by Karina Tarango-Solis.
Signature of employee
cal\ Ain/ly ECIldiS "61
rfgdY - ' 1' PICA(11°.
Visit us at our website: www.derkofcourt.rnaricopa.gov

011=11111. Tarango-Solis,Karina MCVNEX
(Paycheck View MCY-Earnings Taxes / Deduction-el
Name Tarango-Solis,Karina Confirmed Check
Checkt, Issue Date Earnings Taxes Deductions Net Pelf
22381798 05/18/2016 784.91
r Regular and Overtime Earnings 1 Taxes F:67
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ADP Enterprise HR screen print as of: 05/2512016 09:01 AM

Maricopa County
Human Resources
Memo
To: Fran McCarroll, Clerk of the Board MAY 25
CLERK ER .,ARD OF SUPEfev15.!
From: Linda Widner 1/6 LA(IV-A-A—(2
Date: May 25, 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 22
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: 5( 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.
B.47744 19 (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 5-/ 2-0/ (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 $ 70) / g‘ • 5— ? .(3)
Signed: (4)
Note: Please attach- a copy of t warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
(5) Subscribed and sworn to before me this aNk-t day of V---ttok 201
Qatztvt. Wctkii/m
NOTARY PUBLIC
My commission expires: MARICOPA PubNc- Stet COUNTY of Arizcoe
-01 tS My Corenlesion Expire. (seal)
November 9, 206
Warrant/Check Number 002Z5Si /7‘
(if known) (6)
Original Date of Issue
(if known) (7)
Ir
Reason for original issue of Warrant/Check (8): .•III••
›K Payroll INJ
LI For Services or Goods furnished
LI Treasurer's refund/payment
CI Other: r--
Revised April 2015 APPROVED A.R.S. 11-632 & 11-644
MAY 6 2016
DAT
'6-Cr-IRK, BOARD OF SUPERVISORS
MARICOPA COUNTY