050416 DUPLICATE WARRANTS - 6_REDACTED.PDF

Maricopa County
Human Resources
Memo
To: Fran McCarroll, Clerk of the Board
From: Debbie Upton
Date: April 13, 2016
Re: Replacement of Lost Payroll Warrants
Please find attached I 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 Upton. 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 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.
Yanais Duarte (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 4/6/2016 (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 1replacement
warrant/check be issued to him/her in the sum of $ 768 .43 (3)
Signed: 41/114±CL (4)
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
(54Subsci1led and sworn to before me this 1'A day of 0 r 1 1 20_11z_
OTARY PUBLIC ADRIENNE DURAItil
j; I-; r.v vrzere
I
Uy commission expires: —spires
71'10////2r,9 i) de) a February 1, 2018 (seal)
Warrant/Check Number 0022370721 ADRIENNE DURAN
of Mays
COUNTY
4/6/2016 ton EOM
1, 2018
Reason for original issue of Warrant/Check (8):
Ili Payroll
1=1 For Services or Goods furnished
1E1 Treasurer's refund/payment
ID Other: S30410SR Ntik1f1H
Revised April 2015 )? a J V Wd Z I Scit 632 & 11-644
16
E:A:-1;) C);- SUPERVISORS
MAW:CPA COUNTY

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MC1 Maricopa County Pay Group: NEX Separate Check #
5420 - Legal Defender Legal Services Period. . _ End 03/27/2016 Reprint: N
!EX- Non Exempt - Page: 1041 Adjustment: .N.-.
Active 03/14/2016 Reg/FT Line: 7
Enk,,rpiso HR screen print as of: 04/1212016 04:15 PM