Extracted text (via tesseract_tsv)
3029 characters
Maricopa County Human Resources| To: Fran McCarroll, Clerk of the Board From: Wanda Childers ~ Date: November 25, 2015 Re: Replacement of Lost Payroll Warrants Note - recei veal Cheat jack shredaal by postoHier 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 erated ay fis OF Fee Thank you. Replacement Lost Warrant Form NOV 25 2015 02/25/2015 MARICOPA COUNTY CLERK BOARD OF SUPERVISORS. Deagaed ota Frourcdesk fe Application for a Duplicate or Stale-Dated Warrant/ Check Affidavit/ Claim Form This application is for: (ma Duplicate or L] 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. Velia Urias (1), being first sworn, upon oath deposes and says: Name/Claimant 11/18/2015 On or about (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 $ 140.00 (3) L / tg “Unrag Signed: J ) (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 Thy/ day of od YU 20/4. LG) haf ot hake NOTARY PUBLIC EB, GLORIA J, NICHOLS My commission expires: (eS) Wiolay Public. State of Azone NOt ICOPA COUNTY FE Me 2.3 201K wi” Wy Commission Expires Feb. 28, 2010 (seal) rE a 22331381 “een [11/18/2016 Reason for original issue of Warrant/Check (8): ee Payroll m © CL] For Services or Goods furnished [1 Treasurer’s refund/payment CL] Other: Revised April 2015 A.R.S. it 632 & 11-644 2 NOV 0 2015 RR vriasvelia-mcvere ( Paycheck View | MCY-Earnings [ Taxes [ Deductions [ _Garnishments | Special Accumulators [ Distributions - Name Urias,Velia Confirmed Check Check# Issue Date Earnings Taxes Deductions Net Pay 22331381 11/18/2015 140.00 140.00 = Overtime 7 ——— _ at Regularand Earnings tes Reg Hours Reg Pay OT Hours OT Pay +. bad ~ OtherEarnings a _~ Deductions ay Code Hours Amounts Add to Gross) = . . aa EBT 1.00 25.00 Y EPW 1.00 100.00 Y ESU 1.00 5.00 Y ETO 1.00 10.00 Y a = ADP Enterprise HR screen print as of: 11/25/2015 10:47 AM