DUPLICATE WARRANTS - 4 - REDACTED.PDF

INTEROFFICE MEMORANDUM
Ilaricopa County Education Service Agency
TO: Cferkof the cBoarcf
FROM: DEA.911W EAIIL
SUBJECT: Affidavits — Wcpfacement of Lost /Stale Warrants
DATE: 2/16/2016
(Please find attached Affidavit/Notice of Craim(s)for Cost warrants for inclusion on
the ne,ct avada6Ce cBoarclagencfa.
The attached item(s) have 6een researched to ensure that the warrant(s) in
question have not 6een cashed or previously re-issued
The original- warrant (s) have had a stop payment done.
If you have any questions, please contact DeAnn Emd at (602) 372-8425 or via e-mail
at garnishments@mcesa.maricopa.gov . Approved Affidavits may 6e routed 6ackto the
Waricopa County Education Service Agency at 4041 X. Central- Avenue #1200, ( 12th
Efoor) Thankyou.
Fund 781 LOIS FURLAX $167.32
REC
FEB 201 6
M/FKOP OU Nfl-"Y
CLERK BOARD OF SUPERVISORS
1/0 Mod (3,

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: I 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.
LOIS FURLAN (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 27TH OF JANUARY 2016 (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/chec, issue,c1 to hirer in the sum of $ 167.32 .(3)
(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) Sub crib and sworn to before me this CO 6--- day of - -f e-emitctf 20 ke .
-,
1 `• ,,
NOTARY P BLIC NOTARY KI M P S UBI rilrl C , ARIZONA II \ I C
MARICOPA COUNTY
My Commission Expires
My commission expires: June 11, 2018
(seal)
Warrant/Check Number 160058299
(if known) (6)
Original Date of Issue 27TH OF JANUARY 2016
jif known) (7)
Reason for original issue of Warrant/Check (8):
Payroll
111 For Services or Goods furnished 7-) C7 SUPERVISORS
sTOUNTY
LI Treasurer's refund/payment
LI Other:
SAPROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc A.R.S. 11-632 & 11-644
Revised April 2015

Maricopa County
Human Resources
Memo
To: Fran McCarroll, Clerk of the Board
From: Wanda Childers
Date: February 16, 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

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.
Natalie L. Graham (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 02/10/2016 (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 $ 921.00 .(3)
(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 6 14/ day of FP,6(107 20 /6 .
atv10- •
NOTARY PU
AMY M. ECHOLS
My commission expires: Notary Public State of Arizona
Not/eimbe r My MAR Commission ICOPA COUNTY Expires (seal)
November 24, 2018
Warrant/Check Number 22355761
(if known) (6)
Original Date of Issue 02/10/2016
(if known) (7)
Reason for original issue of Warrant/Check (8):
.1 Payroll
El For Services or Goods furnished
LI Treasurer's refund/payment
El Other: ci) rr/
APPROVED I
Revised April 2015 FE1311 A.R.S. 11-632 & 11-644
8 2016
p4. 40 pick. we
K, BOAROOFSOPETTUTE-OFi
MARICOPA COUNTY

Name Graham,Natalie L Confirmed Check
Check#1 Issue Date Earnings Taxes Deductions Net Pay
22355761 02/10/2016 921.00
Reduiarand Overtime Earnings Taxes
Other Earnings r Deductions
ADP Enterprise HR screen print as of: 0211612016 03:49 PM

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
February 16, 2016
TO: Maricopa County Payroll
FROM: Clerk of Court Human Resources / Natalie Graham
Re: Lost Paycheck
The paycheck dated 02/10/2016 did not arrive in the mail and therefore was
not received by Natalie Graham.
i?6,7/4
Signature of iriployee
jdALLOA/1 02 .6 /40
Date
Visit us at our website: www.clerkofeourt.maricopa.gov