060816 DUPLICATE WARRANTS - 6_REDACTED.PDF

Maricopa County
Human Resources
Memo C:7-7
Z%. 1. •
To: Fran McCarroll, Clerk of the Board
From: Debbie Milliron
Date: May 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 Debbie M. at ext. 62406 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 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.
—DR(ek 1w/el (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about —i-Lizsc4y fr(-(( cA (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 $ 6.,9'• .(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) Subsc 'bed and sworn to before me this /6 day of 71.7a7- 20/6.
a 2k2Le ,ilifi-
OTARY PUBLIC
e‘ „0 ,, ',4 :., JULIA MARIE JETT
My c.puimission expires: t . Notary Public - Arizona
74,(: $: ,c V. 14. 'Jr - z. ..-' Maricopa County
My Comm. Expires Feb 20, 2020 (seal)
Warrant/Check Number
(if known) (6)
Original Date of Issue
(if known) (7)
Reason for original issue of Warrant/Check (8):
X—Payroll
0 For Services or Goods furnished
El Treasurer's refund/payment
0 Other:
Revised April 2015 A.R.S. 11-632 & 11-644

Maria Cea9Iske - COBX
From: Deborah Mil!iron HRX
Sent: Thursday, May 19, 2016 8:24 AM
To: Maria Ceaglske - COM
Subject: RE: Affidavit/Claim Form
Apologies... it Is for
Check #22378009 issued on 5/4/2016 $629.38
- Soheerer,Derek I Company. PAC1 Off Cycle: N
IVEC1 - Maricopo County Pay Group:. EXi4 Separate Check it 0
44130 - Comprehensive Planning Period End 0412412016 Reprint: N
Ent - Exemig EEs Page: 378 AcOustment: N
Active ovosem RegiFT Line: 5
811119267 - Scheerer,Derek I - MC11EXM
Paycheck view r MC"- Earnings r Taxes r Deductions r Garnishments r Special Accumulators r Distributions
Name: Scheerer ,Derek 1 Conirmed Check and Advice
Chectoli Issue Date Earnings Taxes Deductions Net Pay
22378009 0510412018 1,25877
ChecklAcivicet Type Accountt Amount
1821418 Checking 25378678 132939
Transit*: 314074289
22378009 Issue Check 62938
Transit:
Thanks
Deborah Milliron
Payroll Specialist Lead
M a ricopa County
Human Resources — "Your Partner for Success"
millirond@mail.maricopa.gov
Tel: 602.506.2406
Fax: 602.372.8277
http://www.maricopa.gov/human resources/
301 W Jefferson, Phoenix, AZ 85003
OUT OF OFFICE DATE 6/06/2016
From: Maria Ceaglske - COBX
Sent: Wednesday, May 18, 2016 4:36 PM
To: Deborah Milliron - HRX
Subject: Affidavit/Claim Form
Ms. Milliron,

Earnings Statement
Maricopa County
301 VV Jefferson SL Page 001 of 001
Suite 220 Period Ending: 04/24/2016
Phoenix, AZ 85003 Advice Date: 05/04/2016
602-505-3519 Advice Number: 0000000080
Batch Number: 609/50001
Taxable marital Statun: M
Federal: 2 11111111
State AZ: 4.2t
Local: 0
Earnings Rate Hours This Period Year-to-Date This Period Year-to-Date
Prenote sent for account(s)
AEA-122100024 Account #-B22093311
T-J jf6C( iti( fit
f k
IeLo ro\tA._ /40(r9
1/00L 061 fa
(301 (A) , c)-9-1)7crso,
q6C rj
tioli-Ar1-5Z___
-
uf of Third 5147 sxmcwiap Eicsiffol
17-1

INTEROFFICE MEMORANDUM
Ilaricopa County School-Superintendent's Office
TO: CLERK, OE DIE WARD
FROM: gfrtilrie Thompson
SUBJECT: Affidavits
DATE: 5/17/2016
Please find attached 2 Affidavit/Tiotice of Claim(s)for lost warrants for inclusion on
the next available Ooard 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.
lf you have any questions, please contact %taw (Thompson at 506.3898 or via e-mail at
mthompson@mcesa.maricopa.gov . Approved Affidavits may be routed back to the
Superintendent of School finance Division at 4041 N. Central . Avenue #1200, ( 12 th
'Floor) Thankyou.
#49 PALO VERDE JODT CARTER $40.00
#90 SADDLE 115 IIT STEVE J0.7 -1XSONAZ COACYCES ASSOC $250.00
.4 3 5 -d2 f, szs
-, -"Co 6 Wt9o5i-4-e-. /11/4/4 Z-
RECEIVED
MAY 1 8 2016
MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS

vIR
AFFIDAVIT Ai? 7', 1 71 17
DATE MAN 9 201a
'
STATE OF ARIZONA
IIERK ECARD 3 SUPERVISORS
COUNTY OF MARICOPA MARICOPA COUNTY
Jpst4Carly-
, being first duly sworn, upon oath deposes and says:
That on the c&J day of rel map 14, , he presented to f vEs D
District of Maricopa County, Arizona, for payment, a claim for services rendered
or supplies furnished during the
month of :Ta,nitac3 20 tp, said claim being in the sum of
Dollars, ($ LAO. 00 ) in payment of which the
Superintendent of Schools caused his/her Warrant Number 400 6.80,0a to be
issued on _E€b - 201&7, drawn on the oeL Fund of NES
District of Maricopa County, Arizona.
Affiant further says that although he/she was informed and believes that the above
mentioned warrant was regularly issued, the same has never been received, or has
been lost.
VVHEREFORE, affiant prays that the Board of Supervisors order and the
Superintendent of Schools issue to him/her a duplicate of said Warrant Number
6s66g, in the sum of $40, CO
Subscribed and sworn to before me this 1 ,,) ,+1,1 — day of
My commission expires: J)(20/o9.019
Following approval please return this affidavit to the Maricopa County School Superintendents Office.
JODY STANBERRY
Notary Public - Af1101111
Maricopa CovMy
My Comm. Expires Nov It 2019

Schools Affidavit/Claim Form
Application for a Duplicate Warrant/Check (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.
.31'60-e-nlOtoiSo, //lE Coacie61.),,,being first sworn, upon oath deposes and says:
Name/Clai ant (-Fs 5 oci
On or about Hal (D\ c JiIf3 (clate)(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 im/her in the sum of $ c a:),C:a .(3)
igned: 34-e()-e thr e)------- (4)
(5) Subscribed and sworn to before me this
STERNER
Nottuy Pak • StEtte of Arizona
iyAR r CeobcoPif sAsilCoi.n° y 2Ex U0N1PTY 8ires
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
Warrant/Check Number
(if known) (6) qa;t1RC<CZO
Original Date of Issue MAN 19 Ziii6
(if known) (7) 504, \'S I)
Reason for original issue of Warrant/Check (8): _ SOAF,Z • ORS
CI Payroll MARICOPA COUNTY
EfFor Services or Goods furnished 3016 c13:20Q.)ti.C.ilL)
Eli Other:
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc
Revised June 2015 A.R.S. 11-632 & 15-999

Arizona Coaches Association
Steve Johnson, Executive Director
5529 West Zoe Ella Way
Glendale, AZ 85306
To Whom It May Concern,
I am the Executive Director for the Arizona Coaches Association and am
responsible for the issuance of checks and keeping the records of the
association.
Thank you for notifying me of the check that was issued to the ACA. It took
me longer than anticipated to get the information that you were requesting..
Respectfully,
Steve Johnson