Extracted text (via pymupdf_layout)
3791 characters
Maricopa County Human Resources Memo To: Fran McCarroll, Clerk of the Board From: Wanda Childers Date: December 18, 2015 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. Thank you. 0,0-urthi t\I-orYx) 19(4)4,43,4-e-n A-ati-01--ratoi 40 14-Z P Replacement Lost Warrant Form 1 02/25/2015 G #‘\ Oce'\ §CY' A p p Al9tion for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: 0 Duplicate or 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. Rosalind Akins (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 5/06/15 (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 $ 1176.39 .(3) Signed: Rosalind Akins (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 6-0 day of -DP f e,Y4er 20\5 . NOTARY PUBLIC ESHAWN-FONTAAPETERSON Notary Pubic - $tele otkizona My corrulssion expires: My MARICOPA Commission COUNTY Expires NWeing_ 9 ano- November 9,2017 (seal) Warrant/Check Number 22275849 (if known) (6) Original Date of Issue 5/6/15 (if known) (7) Reason for original issue of Warrant/Check (8): El Payroll L 0 For Services or Goods furnished 0 Treasurer's refund/payment 0 Other: APPROVED A.R.S. 11-632 & 11-644 Revised April 2015 DATE_ DM 2 1 2015 B D S RS MARICOPA COUNTY Wanda Childers - HRX From: Renee Hernandez - HRX Sent: Friday, December 18, 2015 12:07 PM To: Wanda Childers - HRX Subject: FW: Stale-dated Check Attachments: aff lost_wage.pdf Here is the email. Renee Hernandez Payroll Accountant Maricopa County Human Resources — "Your Partner for Success" hernandezr033@rnail.maricopa.gov Tel: 602.506.7094 Fax: 602.372.0277 http://www.maricopa.gov/human_resources/ 301 W Jefferson, Phoenix, AZ 85003 From: Renee Hernandez - HRX Sent: Wednesday, December 16, 2015 1:08 PM To: Rosalind Akins - PHSX Cc: Tanee Morris - HRX; Troy Marshall - HRX Subject: Stale-dated Check Ms. Akins, We received notification from ADP that a payroll check that was issued to you on 05/06/2015 in the amount of $1176.39 on Check # 22275849 was never negotiated. The check is no longer negotiable and would need to be re- issued. Please complete the attached Affidavit with Notary signature and provide the original copy to the Payroll Department for re-issuance of your check. You can contact the front desk at 602-506-3519 for further assistance on how to submit the Affidavit. Thank you, Renee Hernandez Payroll Accountant Maricopa County Human Resources — "Your Partner for Success" hernandezr033@mail.maricopa.gov Tel: 602.506.7094 Fax: 602.372.0277 http://www.maricopa.gov/human_resources/ 301 W Jefferson, Phoenix, AZ 85003 2