DUPLICATE WARRANTS - 5_REDACTED.PDF

CLERK
e HaRicors D ER Cy
coungg’S Maricopa County
Human Resources
206 JAN 21 PH 2:50
iv divic vel
als
Viemo
To: Fran McCarroll, Clerk of the Board
From: Wanda Childers
Date: January 21, 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: [mm] Duplicate or C1 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.
Heather Joseph (1), being first sworn, upon oath deposes and says:
ame/Ulaiman
On or about 91/13/2016 (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
1279.50
warrant/check be issued to him/her in the sum of $ .(3)
Signed: CRW), QA Wy\ Ooo ( V\ / (4)
Note, Please attach a copy off fhe warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
(5) Subscribed and sworn to before me this ZI day of on 20 lb :
C eWay Ras
NOTARY PUBLIC
EILEEN WILLIAMS-PREAS
gm,
Notery Public - State of Arizona
My commission expires: My Commission
iF -7ZOIS it insbtt le (seal)
Warrant/Check Number
22348713
(it known) (6)
Original Date of Issue
01/13/2016
(if known) (7) ~-=apavrTr
’ Fr mw V ave a Ss
Reason for original issue of Warrant/Check (8): oS a
ay
Payroll 7) BE
BS
0 For Services or Goods furnished RK SOARDOF SUPERVISORS 4.2 ~ m
|
1 Treasurer's refund/payment UOT ne
~ Oe
C1 Other: a ;
Revised April 2015 A.R.S, 11-632 & 11-644

| vt SBN Poypetia Win ho
8) ory ON Vern Seen I “AIMOW
—ichuyaops of Ai)

GE - J oseph,Heather M -MC1/EXM
{ Paycheck View | MCY-Earnings [ Taxes [ Deductions if Garnishments { Special Accumulators [ Distributions
Name Joseph,Heather M Confirmed Check
Checka Issue Date Earnings Taxes Deductions Net Pay
Regular and Overtime Earninas
OtherEarnings r=] ~ Deductions
ADP Enterprise HR screen print as of: 01/21/2016 02:34 PM