042016 DUPLICATE WARRANTS - 3_REDACTED.PDF

Maricopa County
Human Resources
Memo
To: Fran McCarroll, Clerk of the Board
From: Debbie Upton
Date: March 29, 2016
Cr)
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: D Dupiic% tp p s!-Ale1p4t1d (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.
SCI:NIJatelaima-nt (1), being first sworn, upon oath deposes and says:
‘61
On or about O' 13. 1(.._c, (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
warra t/check e is er in the sum of $ RUat .(3)
r
Signed: (4)
Not( : ase attach aopy 7 of th arrant/check if available and/or any other
evidence that a warra eck was c in Ily issued.
(5) Subscribed and sworn to before me this ,Z9'47--- day of Aile,-0/\ 20 C,.
RTINEZ
Notary Public - Arizona
Maricopa County
My commission expires: My Comm. Expires May 3, 2019
05/0// 9- 0-I-I-•wmar-I• 77gr)%
Warrant/Check Number
(if known) (6) aU-6‘62a3sO
Original Date of Issue
(if known) (7)
Rgasjan for original issue of Warrant/Check (8):
Payroll
0 For Services or Goods furnished
LI Treasurer's refund/payment
0 Other:
C:\Users\williamse\AppData \Local \Microsoft\Windows\Temporary Internet Files\Content,Outlook\HTTDL74G\Warrants Checks notice
of claim.doc
Revised April 2015 A.R.S. 11-632 & 11-644

ucHom IT mil-Li Cok-)ct:
0 NJC 2 Lp prNs c_04 a \rksz_cdk k.dt-Jot_
Se.svA o -i-o trN OtcA ckcXares_s
n-ever cec-e.t \Jed (T.t
fy- \1 ici._clk.c1.r€_,ss an 04P-- -Poetcd i
chQsjc lc:3e_ V ‘thes4 a-no4
i or,
vst).e. L.k-Doutok
v\12..uo devld< c).-i SO I
Kao
Kox I crirz Q_Dury-\-k_f Po_Li r-o t \ FR
eRCe-rson
Spin

Distributions
Name Fricovsky,Sophia Elizabeth Confirmed Check and Advice •
1 Check t Issue Dat€ Earnings Taxes Deductions Net Pay
i
i 22366320 03123/2016 1,061.85
1—
i Check/Mvice# Type Account# Amouni
1586515 Savings 100.00
22366320 Issue Check 961.85
.,
ADP Enterprise HR screen print as of: 03/29/2016 01:25 PM

Maricopa County
Human Resources
Memo
0 r_o
ToA Fran McCarroll, Clerk of the Board (-3 0 0
on C)
> a rn I-
From: Wanda Childers ` „..„ .7.3
Date: March 29, 2016 --< 0
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 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

?Jb 7 c-; c ! -
Application for a Duplicate or Stale-DatedW iarrant/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.
Ruben Vazquez (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 03/23/2016 (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 $654.82 .(3)
Signed: Z,Pti e (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 WI day of laVAA7- 20141.
(1)(104Mv0 —
NOTARY PUBLIC
My commission expires:
tk-a1•2-DIS (seal)
Warrant/Check Number 22366340
(if known) (6)
Original Date of Issue 03/23/2016
(if known) (7)
Reason for original issue of Warrant/Check (8):
ill Payroll
III For Services or Goods furnished
LI Treasurer's refund/payment
CI Other:
Revised April 2015 A.R.S. 11-632 & 11-644
I< BOARD OF SUPERVISORS
MARiCOPA - - - - COUNTY -

/96/(e).,, ,s' C eiSC -,//7 -771 C,

r Paycheck View MCY-Earnings Taxes Deductions Garnishments Special Accumulators Distributions
Name Vazquez,Ruben Confirmed Check
Checkit Issue Dat€ Earnings Taxes Deductions Net Pay
1 22366340 03/23/2016 654 82
COlvvItirttiL
OtherEarninos — - Deductions
ADP Enterprise HR screen print as of: 03/29/2016 10:23 AM

Application for a Duplicate or Stale-Dated Warrant/Check
MA 29 A cl: b
Affidavit/Claim Form
This application is for: g 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.
Christopher T Chaduka (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about March 23, 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 j:).§k issued to him/her in the sum of $ 998 .53 .(3)
Signed: vo - (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) Subscribe sworn to bef(pre me this aq day of Mctrok 20 /6 .
(
LI,LiirE0AJ/0
tS19TENE-OtrtNTAfilttA
NOTARY PUBLI Notary Public - Arizona
Maricopa County
FoRmission, exp), My Comm. Expires Oct 19, 2017
Ati,k1). &-Ch I (seal)
Warrant/Check Number 0022366410
(if known) (6)
Original Date of Issue March 23, 2016
(if known) (7)
Reason for original issue of Warrant/Check (8):
11 Payroll
O For Services or Goods furnished kAA.PrnPA 3GARD 3F :MINTY SuPERVISORS
O Treasurer's refund/payment
O Other:
CAUsers\williamse\AppData\Local\Microsoft\Windowsgemporary Internet Files\Content.Outlook\HTTOL74G\Warrants Checks notice
of Revised claim.doc April 2015 A.R.S. 11-632 & 11-644

I &irk OW,0\- c9i\c/wt, \ k../\
\ C \ b-eColv5t ( 4 ('01 v cri-
cPC Q -C\J R (
tA s

Chaduka,Christopher I - MCVNEX
Paycheck View 1 ' NicY-Earnrngs r Taxes Deductions IGarnishments r Special Accumulators r Distributions I
Name Chaduka,Christopher T Confirmed Check
CheckP Issue Date Earnings Taxes Deductions Net Pat
22366410 03/23/2016 998.53
Reaular and nvPrtirinp I-arninn
OtherEarnings Deductions
ADP Enterprise HR screen print as of: 03/29/2016 10:15 AM