Extracted text (via tesseract_tsv)
28180 characters
INTEROFFICE MEMORANDUM
Maricopa County Education Service Agency (aka
Maricopa County Superintendent of Schools Office)
TO: CLERK OF THE BOARD
From =» Millie Thompson
SUBJECT: Affidavits — Replacement of Lost Warrants
DATE: 8/12/2015
Please find attached 7 Affidavit/Notice of Claim(s) for lost warrants for inclusion on
the next available Board agenda
V The attached item(s) have been researched to ensure that the warrant(s) in
question have not been cashed or previously re-issued.
V The original warrant(s) have had a stop payment done.
If you have any questions, please contact Millie Thompson at 506.3898 or via e-mail at
millie. thompson@mcesa.maricopa.gov. Approved Affidavits may be routed back to the
Superintendent of School Finance Division at 4041 N. Central Avenue #1200, ( 12%
Floor) Thank you.
#62 UNION TWIN CITYHARDWARE — $722.09
#214 TOLLESON UNION SHEILA POTEAT $104.47
#68 ALHAMBRA JIM NUGENT $328.90
#65 LITTLETON MARTHA ESTRADA $173.33
#65 LITILETON DELIA TARANGO-HAILEY $157.52
#59 LAVEEN = PAULA KIRK $824.86
#60 HIGLEY CHRISTOPHER GUDE — $142.93 RECEIVED
AUG I 3 2015
MARICOPA GOUNTY
CLERK BOARD OF SUPERVISORS
dull offecc nad aly
AFFIDAVIT L
STATE OF ARIZONA
COUNTY OF MARICOPA
“Twin City Hard WAVE, being first duly sworn, ‘isos oath deposes and says:
That on the ot day of Ayal. 2015, he presented to. UESD 4 UZ
District of Maricopa County, Arizona, for payment, a claim for servicés rendered
5 1 11 1 1 4 667 1164 177 36 95.972763 furnished
5 1 11 1 1 5 896 1164 116 42 96.464714 during
5 1 11 1 1 6 1040 1164 59 36 95.969788 the
3 1 11 2 0 0 371 1224 1724 299 -1
4 1 11 2 1 0 385 1224 1634 94 -1
5 1 11 2 1 1 385 1262 119 36 82.301277 month
5 1 11 2 1 2 523 1258 11 59 21.798964 —
5 1 11 2 1 3 561 1264 36 35 95.401642 of
5 1 11 2 1 4 696 1224 45 88 59.101631 h
5 1 11 2 1 5 745 1228 87 74 33.865891 an
5 1 11 2 1 6 960 1259 9 58 0.000000 .’
5 1 11 2 1 7 1018 1235 102 64 62.926964 2019
5 1 11 2 1 8 1140 1290 6 12 28.103184 .
5 1 11 2 1 9 1204 1264 84 54 78.174858 Said
5 1 11 2 1 10 1339 1264 97 37 78.174858 claim
5 1 11 2 1 11 1492 1265 102 43 82.353622 being
5 1 11 2 1 12 1648 1265 31 35 84.453087 in
5 1 11 2 1 13 1735 1266 73 40 84.453087 the,
5 1 11 2 1 14 1849 1275 78 37 23.834791 sum
5 1 11 2 1 15 1982 1267 37 35 80.745430 of
4 1 11 2 2 0 367 1301 1728 121 -1
5 1 11 2 2 1 367 1320 152 102 0.000000 Seuin
5 1 11 2 2 2 544 1318 143 78 0.000000 uel
5 1 11 2 2 3 751 1301 132 121 2.513924 “went
5 1 11 2 2 4 923 1315 193 84 0.000000 THQ
or supplies
S 122.09 “in. payment: of which ihe -
Superintendent of Schools caused his/her Warrant Number L500 SEE 0 to ba
issued on Way \% j 2015, drawn on the OOL Fund of LES Dit (2.
District of Maricopa County, Arizona.
Affiant further cays that although he/she we informed and believes that the above
mentioned warrant was regularly issued, the same has never been received, or has
-
been lost.
WHEREFORE, affiant prays that: ‘the Board of Supervisors order and the
Superintendent of Schools Issue to him/her a duplicate of said Warrant Number
5ODLE4R0 7 in the sum of $ (kA.04
Signed: ee
BROKE Mice Adeovunt ANalyse-
Subscribed and sworn to before me this 5S day of Avg vst 20 fs
MATTHEW JOHN KUTH
IOTARY PUBLIC - MINNESOTA
PODINGSION EXPIRES 01/31/17
- My commission expires: [-3/-19
Following approval please retum this affidavit to the Maricopa County School Superintendents Office.
AFFIDAVIT
STATE OF ARIZONA
COUNTY OF MARICOPA
Vale pbuh faok Ls teye Whe see th
first upon oath deposes and says:
foarvyx® 4 Posi on
That on the 75 _day of 2015, he presented to (alle wy Lr WON Ag \y\
Sond)
District of Maricopa County, Arizona, for payment, a claim for services rendered
or supplies furnished during the
month of Proc | 20\, said claim being in the sum of
One hundred four Yeo ponars, slot y in. payment of which — the
Superintendent of Schools caused his/her Warrant Number Qe YE2323 to be
issued on Pr | \|2\ 20\S_, drawn on the @S¢y_ Fund of lex Uryon
, ol
Schock
Tigh
District of Maricopa County, Arizona.
Affiant further says that although ‘ie/she was informed and believes that the above
mentioned warrant was regularly issued, the same has never been received, or has
been lost.
WHEREFORE, affiant prays that the Board of Supervisors order and the
Superintendent of Schools issue to him/her a duplicate of said Warrant Number
NSOOEZ3Z5 in the sum of $|( jp uf
.
A tet? Bhar b
signed
Subscribed and sworn to before me this 50) ig of ( 20 [D-
_, b.
ve
NOTARY PUBLIC
= | ae
My commission expires: Arg.
Foliowing approval please return tnis affidavit to the Maricopa County School Superintendents Office
%, HEATHER R. HARRIS
=) Notary Public - State of Arizona
MARICOPA COUNTY
My Commission Expires
August 15, 2018
AFFIDAVIT
STATE OF ARIZONA | __ CLERK BOARD OF SUPEPVISOR
COUNTY OF MARICOPA
a]
ea
* EO IN V4 , being first duly sworn, upon oath deposes and says:
sersott*
(name and title of
That on the nig dayof Stone 20/S._, he/she presented to
Cs
District of Maricopa County, Arizona , for payment , a claim for services rendered or supplies furnished
during the month of Ore. 20_) S_, sald clalm being In the sum of (8! N22 Go )
_) nvee \Qurdvect erly Cunt clo) \es os of
payment
Which the Superintendent of Schools caused his/her Warrant Number ¢} S6162222 to be
Issued on the 4 Ine \& ,20\ , drawn on the CHo Fund of ‘AYneomdarcs,
District of Maricopa County , Arizona.
Afffant further says that although he/she was Informed and believes that the above mentioned warrant
Was regularly issued, the same has never been received , or has been lost.
WHEREFORE, afflant prays that the Board of order and the Superintendent.o sess issue
akon) ¥ Des |
to him/her a Warrant Number OS 02833 _ inthe sum of $‘ P
— eye
tie & title of authorized personneal)**
25th, ok alt
Subscribed and sworn to before me of we
this
NOTARY PUBLIC :
1\2-S$.7o0IQ
My commission expires:
Following approval please return thls affidavit to the Maricopa County Education Service Agency Office.
KYLE GRAY
Notary Public - Arizona
Maricopa County
My Comm. Expires Dec 8, 2017 }
Stop Payment
A
ALND.
(— siness Resources Affidavit
STATE OF ARIZONA
}
COUNTY OF MARICOPA
QIavr Waa Es \ AQ
, being first duly sworn, upon oath deposes and states:
That on the a day of aqua 20 L 2 he/she presented to Littleton Elementary
, ,
School District No. 65, of Maricopa County, for payment, a claim for services rendered or supplies furnished during
the month of y, Lue said claim being in the sum of C22¢ Ax helred &
Ment Tee ~
JOO
Dollars ($ (T2823 _ ) in payment of which Littleton Elementary School District No. 65 caused warrant/check
number AS OO9*4/G7 tobeissuedon _ 70 _ day of Yu re 20 /8~
,
drawn on the warrant/check fund of Littleton Elementary School District No. 65 of Maricopa County, Arizona.
A*“ant further states that although he/she was informed and believes that the above mentioned warrant/check
was regularly issued, the same has never been received, or has been lost.
Wherefore, affiant requests that the Governing Board order and the Littleton Elementary School District No. 65 issue
to him/her a replacement of said warrant/check number/O COG*YG Z_inthesumof$ 773,33
Vssdda CE ch
Sfgnature
Subscribed and sworn before me this Sb day of Fygush: 20 [Ss
_.
ae
sife: sry bli
e MARICOPA COUNTY
7
My Commission Expires
Na COWIESION Expires
03/2013
ae |
A
Stop Payment
Seno
Business Resources A ffi d a VI t
STATE OF ARIZONA
} | APE ROVED :
COUNTY OF MARICOPA
DAT
|
De Wo Te
Sono ratley
, being first duly sworn, upon oath deposes and
states:
That onthe 2 day of Racgus
€c ,20_1\7 he/she
presented to Littleton Elementary
School District No. 65, of Maricopa
County, for payment, a claim for services rendered
} Or supplies furnished during
the month of w\4 17-0
, Said claim being in the of 27@ Acnatred bed, Too
sum Tithe Seuer v
Dollars ($ WAX ) in
payment of which Littleton Elementary School
District No. 65 caused warrant/check
number 7510 G4H//y
\6 _ tobeissuedon 20 day of June
,20 75—
~ “ant further
states that although he/she was informed and
believes that the above mentioned
warrant/check
was regularly issued, the same has never been
received, or has been lost.
Wherefore, affiant requests that the
Governing Board order and the Littleton
Elementary School District No. 65 issue
to him/her a replacement of said
warrant/check number /{O OF ¥/¥l inthe
sum of $ AY Z Se
Z
Wiiirs
Catt
Subscribed and sworn before methis ____)
2015.
Novem her 21, 20F]
My Commission Expires
V
03/2013
Affidavit
pare, — AU 13 2085
os
State of Arizona E)
4 wi
(County of Maricopa)
Paula Kirk being first duly sworn, upon oath deposes and says: That on the 31st day of July, 2015
he/she presented to the Laveen Elementary School District #59 of Maricopa County, for payment, a
claim for services rendered or services to be furnished during the month of July 2015, said claim
being in the sum of $824.86 dollars
($ 824.86) in payment of which Superintendent of Schools caused his/her
Warrant No. 1-6-0004773 to be issued on July 31, 2015, drawn on the 40/30 fund of Laveen
Elementary School District #59 of Maricopa County, Arizona.
Affidavit further says that although he/she was informed and believes that the above
mentioned warrant was regularly issued, the same has never been received, or has been lost.
WHEREFORE, affidavit prays that the Board of Supervisors order and the Superintendent of
Schools issue him/her a duplicate of said Warrant No. 1-6-0004773 in the sum of $ 824.86.
Rude Kix
Vendor Signature
Subscribed and sworn before me this 3 7A day of hs. ast _, 2015
Ween. MCFicane) (notary public signature and stamp)
NAOMI ORONA
Notary Public - Arizona os . c
Maricopa County - my commission expires Fy 1 22, 2DALb
S/ _ v
s2/ My Comm: Expires Apr-27, 20163
Following approval please return this affidavit to Maricopa County Schools.
|
Schools Affidavit/Claim Form
Application for a Duplicate Warrant/Check (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.
, rt
Gh rt Slop her Oud C
(1), being first sworn, upon oath deposes and says:
Name/Claimant '
Vy
On or about _ July fel i BOIS (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 $ 1¢Q AS (3)
Ch: Hue
Signed: (4)
5 [S,
(5) Subscribed and sworn to before me this day of hngust 20
(Lubin
LA
NOTARY PUBLIC
ATR, OFFICIAL SEAL 1
6%) NICHOLE BOMBARD }
Notary Public - State of Arizona!
A):
myisp lib Oe5") MARICOPACOUNTY !
SS7ais” My Comm. Expires Dec. 30, 2016 | (seal)
Note. Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
Warrant/Check Number
(if known) (6) le00U13D |
Original Date of Issue .
(if known) (7) \ July 1om™, QOS —_ |
,
.
Reason for original issue of Warrant/Check (8): AUG, I 3 0
; -
i=] Payroll — ! a
gikel}
CL) For Services or Goods furnished
(1 Other:
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Schools\Schools-Warrants Checks notice of claim.doc
Revised June 2015 A.R.S. 11-632 & 15-999
MARICOPA COUNTY BOs eee pS
HARICE
Department of Finance
oe
301 West Jefferson, Ste 960 ONG AUG 13 AK Tit 90
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
Date: August 13, 2015
To: Clerk of the Board
From: Beth Brown
Department of Finance
Subject: Affidavit — Replacement of Lost Warrant
Please find attached affidavit for lost warrant to be included on the next available Board
Agenda.
e The attached item has been researched to ensure the warrant in question
has not been cashed or previously re-issued.
e The original warrant has a void/stale date/stop payment done.
Please call me at 506-1329 if you have any questions. Please return the approved
Affidavit to my attention in the Department of Finance, Suite 960.
Thank you.
Re: Julian Valentin
AFFIDAVIT
FOR WARRANT#350032256
STATE OF ARIZONA
COUNTY OF MARICOPA
Julian Valentin being first sworn, upon oath deposes and says:
That on 4/5/2015 presented to Maricopa County, for payment, Reimbursement for
Funeral. In the Amount of: Two Thousand dollars.
In payment of which the Board of Supervisors caused the Warrant
No._ 350032256 to be issued on 6/19/2015 drawn on the Expense Fund.
Affidavit further says that although he/she was informed and believes that the above
mentioned warrant was regularly issued, the same has never been received, or has been
lost.
WHEREFORE, affiant requests that the Board of Supervisors issue to him/her a
duplicate of said Warrant No.350032256 in the sum of $2,000.00
a
Signed: B= «/ I/cc bn ives £ Cn F77E
Julian Valentin
Subscribed and sworn to before me this 0 2 dayof___ August , 2016S
My commission expires: Mov 61 Jove NOTARY PUBLIC
VERONICA RAZO
Notary Public - State of Arizona
MARICOPA COUNTY
My Commission Expires -
November 6, 2018
_
Maricopa County
Human Resources
To: Fran McCarroll, Clerk of the Board
From: Wanda Childers {OC Lora. LO,
Date: August 17,2015
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.
Stale Dated Warrant Duplicate Warrant
Thank you.
AUG 1 7 2015
Replacement Lost Warrant Form MARICOPA COUNTY 02/25/2015
CLERK BOARD OF SUPERVISOF _
srosibead
RICO
aes Bp 2,
Application for a Duplicate or Stale-Dated Warrant/ Check 2
fi |
aa a2
cea, Ws
Affidavit/Claim Form
This application is for: Duplicate or CJ 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.
Bune EU (1), being first sworn, upon oath deposes and says:
On or about 98/12/2015 (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
issued to hi | in the sum of $ \ At. 6D (3)
ie inppner
a.
Signed: —— (4)
aes
Note. Please 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 APPAK day of Progogt 20\>.
Se
eee
NOTARY PUBLIC
TS Se
S) 5 1 26 1 2 8 1542 1976 106 79 74.533455 MARICC
5 1 26 1 2 9 1708 1991 34 8 50.619358 COUNTY
5 1 26 1 2 10 1914 2036 3 15 50.619358 |
4 1 26 1 3 0 495 2019 1001 89 -1
5 1 26 1 3 1 495 2019 430 89 5.456343 Baoan
5 1 26 1 3 2 1268 2054 181 51 14.958677 [Sac
5 1 26 1 3 3 1533 2018 25 98 14.470291 My
5 1 26 1 3 4 1620 2052 92 48 14.470291 Commision
5 1 26 1 3 5 1741 2064 91 34 17.516441 Sxpres
2 1 27 0 0 0 353 2185 858 96 -1
3 1 27 1 0 0 353 2185 858 92 -1
4 1 27 1 1 0 353 2185 502 47 -1
5 1 27 1 1 1 353 2186 317 46 92.138435 Warrant/Check
5 1 27 1 1 2 688 2185 167 39 96.757286 Number
4 1 27 1 2 0 520 2201 691 80 -1
5 1 27 1 2 1 520 2237 41 44 96.853165 (if
5 1 27 1 2 2 575 2237 99 44 96.146172 known)
5 1 27 1 2 3 697 2237 44 44 96.213737 (6)
5 1 27 1 2 4 956 2201 255 43 96.765770 22301493
2 1 28 0 0 0 354 2289 890 91 -1
3 1 28 1 0 0 354 2289 890 91 -1
4 1 28 1 1 0 354 2289 461 39 -1
5 1 28 1 1 1 354 2289 162 39 96.860390 Original
5 1 28 1 1 2 536 2291 94 36 96.241966 Date
5 1 28 1 1 3 647 2289 42 38 97.017807 of
5 1 28 1 1 4 704 2290 111 37 96.491905 Issue
4 1 28 1 2 0 418 2300 826 80 -1
5 1 28 1 2 1 418 2300 22 37 2.100315 Bee
5 1 28 1 2 2 524 2345 32 35 35.287930 ie
5 1 28 1 2 3 568 2344 173 35 31.901802 knowns
5 1 28 1 2 4 957 2308 287 44 96.271545 08/12/2015
2 1 29 0 0 0 528 1463 1366 57 -1
3 1 29 1 0 0 528 1463 1366 57 -1
4 1 29 1 1 0 528 1463 1366 57 -1
5 1 29 1 1 1 528 1463 1366 57 95.000000
2 1 30 0 0 0 321 1631 1966 91 -1
3 1 30 1 0 0 321 1631 1966 91 -1
4 1 30 1 1 0 321 1631 1966 91 -1
5 1 30 1 1 1 321 1631 1966 91 95.000000
2 1 31 0 0 0 1720 1746 490 24 -1
3 1 31 1 0 0 1720 1746 490 24 -1
4 1 31 1 1 0 1720 1746 490 24 -1
5 1 31 1 1 1 1720 1746 490 24 95.000000
2 1 32 0 0 0 425 1844 1551 65 -1
3 1 32 1 0 0 425 1844 1551 65 -1
4 1 32 1 1 0 425 1844 1551 65 -1
5 1 32 1 1 1 425 1844 1551 65 95.000000
2 1 33 0 0 0 1560 1903 367 231 -1
3 1 33 1 0 0 1560 1903 367 231 -1
4 1 33 1 1 0 1560 1903 367 231 -1
5 1 33 1 1 1 1560 1903 367 231 95.000000
2 1 34 0 0 0 425 2095 606 28 -1
3 1 34 1 0 0 425 2095 606 28 -1
4 1 34 1 1 0 425 2095 606 28 -1
5 1 34 1 1 1 425 2095 606 28 95.000000
2 1 35 0 0 0 331 2154 1944 12 -1
3 1 35 1 0 0 331 2154 1944 12 -1
4 1 35 1 1 0 331 2154 1944 12 -1
5 1 35 1 1 1 331 2154 1944 12 95.000000
2 1 36 0 0 0 330 2162 1945 15 -1
3 1 36 1 0 0 330 2162 1945 15 -1
4 1 36 1 1 0 330 2162 1945 15 -1
5 1 36 1 1 1 330 2162 1945 15 95.000000
2 1 37 0 0 0 331 2235 1937 79 -1
3 1 37 1 0 0 331 2235 1937 79 -1
4 1 37 1 1 0 331 2235 1937 79 -1
5 1 37 1 1 1 331 2235 1937 79 95.000000
2 1 38 0 0 0 2271 1667 22 709 -1
3 1 38 1 0 0 2271 1667 22 709 -1
4 1 38 1 1 0 2271 1667 22 709 -1
5 1 38 1 1 1 2271 1667 22 709 95.000000
2 1 39 0 0 0 309 1674 47 710 -1
3 1 39 1 0 0 309 1674 47 710 -1
4 1 39 1 1 0 309 1674 47 710 -1
5 1 39 1 1 1 309 1674 47 710 95.000000
2 1 40 0 0 0 925 2174 11 208 -1
3 1 40 1 0 0 925 2174 11 208 -1
4 1 40 1 1 0 925 2174 11 208 -1
5 1 40 1 1 1 925 2174 11 208 95.000000
2 1 41 0 0 0 331 2338 1936 79 -1
3 1 41 1 0 0 331 2338 1936 79 -1
4 1 41 1 1 0 331 2338 1936 79 -1
5 1 41 1 1 1 331 2338 1936 79 95.000000
2 1 42 0 0 0 357 2438 995 108 -1
3 1 42 1 0 0 357 2438 995 108 -1
4 1 42 1 1 0 357 2438 995 50 -1
5 1 42 1 1 1 357 2443 150 36 96.923691 Reason
5 1 42 1 1 2 525 2441 58 38 96.710472 for
5 1 42 1 1 3 599 2440 150 48 96.530495 original
5 1 42 1 1 4 769 2442 103 36 96.529228 issue
5 1 42 1 1 5 890 2440 41 37 93.033272 of
5 1 42 1 1 6 945 2438 317 46 92.198158 Warrant/Check
5 1 42 1 1 7 1279 2438 73 47 96.838470 (8):
4 1 42 1 2 0 430 2488 207 58 -1
5 1 42 1 2 1 426 2484 44 66 45.348602 KY
5 1 42 1 2 2 502 2488 135 58 96.715752 Payroll
2 1 43 0 0 0 431 2583 740 40 -1
3 1 43 1 0 0 431 2583 740 40 -1
4 1 43 1 1 0 431 2583 740 40 -1
5 1 43 1 1 1 431 2588 35 35 84.092590 O
5 1 43 1 1 2 502 2587 66 36 96.890923 For
5 1 43 1 1 3 583 2586 172 37 96.256584 Services
5 1 43 1 1 4 772 2595 43 27 96.009003 or
5 1 43 1 1 5 830 2584 130 38 96.422279 Goods
5 1 43 1 1 6 977 2583 194 38 95.839722 furnished
2 1 44 0 0 0 2039 2399 42 205 -1
3 1 44 1 0 0 2039 2399 42 205 -1
4 1 44 1 1 0 2039 2527 7 6 -1
5 1 44 1 1 1 2039 2527 7 6 92.650093 é
4 1 44 1 2 0 2048 2473 10 104 -1
5 1 44 1 2 1 2048 2573 8 4 48.639420 €
5 1 44 1 2 2 2052 2473 6 4 3.700285 e
4 1 44 1 3 0 2062 2399 19 205 -1
5 1 44 1 3 1 2068 2597 10 7 40.970039 ©
5 1 44 1 3 2 2068 2548 10 27 40.569153 ed
5 1 44 1 3 3 2062 2502 18 26 13.359404 OS
5 1 44 1 3 4 2071 2448 10 35 49.279579 ed
5 1 44 1 3 5 2069 2399 12 34 26.009331 bed
2 1 45 0 0 0 1174 2604 945 39 -1
3 1 45 1 0 0 1174 2604 945 39 -1
4 1 45 1 1 0 1174 2604 945 39 -1
5 1 45 1 1 1 1174 2604 945 39 95.000000
2 1 46 0 0 0 431 2670 791 126 -1
3 1 46 1 0 0 431 2670 791 139 -1
4 1 46 1 1 0 431 2670 660 47 -1
5 1 46 1 1 1 431 2674 35 35 64.982796 1
5 1 46 1 1 2 497 2671 237 39 0.000000 Treasurer's
5 1 46 1 1 3 752 2670 339 47 91.468544 refund/payment
4 1 46 1 2 0 431 2758 791 38 -1
5 1 46 1 2 1 431 2760 35 36 70.025642 O
5 1 46 1 2 2 500 2758 130 38 94.912796 Other:
5 1 46 1 2 3 1059 2754 163 55 64.907097 [ay
2 1 47 0 0 0 1105 2688 1024 44 -1
3 1 47 1 0 0 1105 2688 1024 44 -1
4 1 47 1 1 0 1105 2688 1024 44 -1
5 1 47 1 1 1 1105 2688 1024 44 95.000000
2 1 48 0 0 0 1892 2348 61 477 -1
3 1 48 1 0 0 1892 2348 61 477 -1
4 1 48 1 1 0 1892 2348 61 477 -1
5 1 48 1 1 1 1892 2711 49 114 5.331755 SiO
5 1 48 1 1 2 1888 2702 69 41 0.000000 :y
5 1 48 1 1 3 1901 2633 42 41 55.020149 VY]
5 1 48 1 1 4 1900 2540 44 48 72.422386 LI
5 1 48 1 1 5 1904 2443 44 66 79.516380 ony
5 1 48 1 1 6 1907 2348 46 67 31.633863 she
2 1 49 0 0 0 649 2766 1498 63 -1
3 1 49 1 0 0 649 2766 1498 63 -1
4 1 49 1 1 0 649 2766 1498 63 -1
5 1 49 1 1 1 649 2766 1498 63 95.000000
2 1 50 0 0 0 356 2910 1835 37 -1
3 1 50 1 0 0 356 2910 1835 37 -1
4 1 50 1 1 0 356 2910 1835 37 -1
5 1 50 1 1 1 356 2915 105 26 96.370720 Revised
5 1 50 1 1 2 474 2915 61 32 96.342331 April
5 1 50 1 1 3 547 2916 68 25 96.342331 2015
5 1 50 1 1 4 1857 2911 82 25 84.139130 A.R.S,
5 1 50 1 1 5 1956 2910 93 26 93.153603 11-632
5 1 50 1 1 6 2061 2911 21 25 93.153603 &
5 1 50 1 1 7 2094 2910 97 25 96.915588 11-644
2 1 51 0 0 0 1125 2838 590 158 -1
3 1 51 1 0 0 1125 2838 590 158 -1
4 1 51 1 1 0 1125 2838 590 158 -1
5 1 51 1 1 1 1125 2838 590 158 95.000000
2 1 52 0 0 0 1125 2985 427 19 -1
3 1 52 1 0 0 1125 2985 427 19 -1
4 1 52 1 1 0 1125 2985 427 19 -1
5 1 52 1 1 1 1125 2985 427 19 95.000000
2 1 53 0 0 0 1103 2992 559 34 -1
3 1 53 1 0 0 1103 2992 559 34 -1
4 1 53 1 1 0 1103 2992 559 34 -1
5 1 53 1 1 1 1103 2994 17 3 49.472660 ~
5 1 53 1 1 2 1130 2992 441 34 31.516911 SGTERK
5 1 53 1 1 3 1274 2988 92 50 95.680779 BOARD
5 1 53 1 1 4 1382 2988 38 50 96.709061 OF
5 1 53 1 1 5 1436 2992 226 34 96.478752 SUPERVISORS
5 1 53 1 1 6 1649 2988 17 50 62.216660 |
2 1 54 0 0 0 448 3072 762 134 -1
3 1 54 1 0 0 448 3072 762 134 -1
4 1 54 1 1 0 448 3072 762 134 -1
5 1 54 1 1 1 448 3072 762 134 95.000000
My commission expires: AW }
Sav rr FY Her LX
Lutz, Eunice - mc1/NEX
Name: Lutz,Eunice Confirmed Check
Check? sue Date Earnings Taxes. Deductions Net Pay
22301493 0822015 729.65
Regular and Overtime Earnings a
Reg Hours Reg Pay OT Hours. OT Pay I
7 [4]
Other Earnings. a
|r|
Code Hours Amounts. Add to Gross.
| |
[4 |4
cs
Tanee Morris - HRX
From: Lutz Eunice 4 0UUts—sSCSCsi‘CS
Sent: Monday, August 17, 2015 9:31 AM
To: Tanee Morris - HRX
Subject: RE: Affidavit of Lost Check
| am requesting a replacement payroll check because my address was entered incorrectly into ADP therefor the check
was never received by me, the check was supposed to had been received on 8/12/2015 yet nothing has been received.
Thank you
Eunice Lutz
Hope this is good.
From: Tanee Morris - HRX [mailto:morrist0O2@mail.maricopa.gov]
Sent: Monday, August 17, 2015 9:14 AM
To: Lutz Eunice
Subject: Affidavit of Lost Check
Good morning Eunice,
| just remembered one small detail about the affidavit. I need a statement from you
saying why the last check was not received by you. From my understanding while
you were here, you stating that your address was incorrect. If you can just put that
in writing (or email) for me, that would be great.
Tanee’ Morris
Payroll & Records Office Assistant
Maricopa County
Human Resources — “Your Partner for Success”
morrist002 @mail.maricopa.gov
* Tel: 602.506.3519
Payroll Fax: 602.372.8722
~
Records Fax: 602.372.8724
http://www.maricopa.gov/human_resources/
301 W Jefferson,Ste 220, Phoenix, AZ 85003
Maricopa County
Human Resources
To: = Fran McCarroll, Clerk of the Board
From: Wanda Childers
Date: August 17, 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.
Stale Dated Warrant Duplicate Warrant
Thank you.
RECEIVED
AUG 18 2045
MARICOPA COUNTY
Replacement Lost Warrant Form 1 CLERK BOARD OF 02/25/2015
ia
in
Application for a Duplicate or Stale-Dated Warrant/ Check
=
i
ae,
Affidavit/ Claim Form COUN
This application is for: CJ 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.
Mary Jane Gibson (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 12/3/2014 (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 $ 155.00 (3)
signed: 7g z= ol = (4)
-
Note, Please attach a copy of the warrant/check if available and/or any other
evidence that. a warrant/check was originally issued.
a A
(5) and sworn to before ye day of ( Lufss 2049 .
mee, ae
ple ie iC
NOTARY
My commission expires:
Teys. (seal)
Warrant/Check Number ot
22241634 un
neues 2
Original Date of Issue =
12/03/2014 =
fe eoowena)
Reason for original issue of Warrant/Check (8): Oo 7
Payroll S =
Cd oe
LC) For Services or Goods furnished S 4
1 Treasurer's refund/payment
C1 Other:
Revised April 2015 Are me — A.R.S. 11-632 & 11-644
Stale Dated Check Claims
1. Please provide a statement validating that there is good and
sufficient reason for not presenting the original
warrant/check for payment before the voided date.
Lz S- peCeriwet LE, ext Aino
Gp foul Ol hea Fog
2. Where would you like us to mail the replacement
warrant/check?
Tn. ALome f
a
3. If available, please attach the original warrantichegk ora
copy along with the notarized affidavit and this form to:
Maricopa County Elections Dept.
Attn: Payroll Division
111 S. 3% Ave, Suite102
Phoenix, AZ 85003-2294
Please contact Deyan Bunjevic at 602-506-2471 or Lorraine
Garrett at 602-506-2492 if you have any questions.
( Paycheck View
Name Gibson,Mary Jane Confirmed
Check# Issue Date Earnings Taxes
22241634 12/03/2014 155.00 155.00
~ Regularand Overtime Earnings rg] 4f Taxes oa
Reg Hours Reg Pay OT Hours OT Pay _ eo
~OtherEarnings rz) 7 Deductions ay)
Code Hours | Amounts Add to Gross, -— —
_
EPS 1.00 115.00 Y
ESU 4,00 5.00 Y
ETO 1.00 10.00 Y
EPT 1.00 25.00 Y el a
ADP Enterprise HR screen print as of: 08/17/2015 04:32 PM
06/17/15
Comments by ADP
returned
funds
Returned Ck #
on
YEAR 2015 by
766 1 30, June Returned ADP
FOND CHECKS WITHIN
ACCT Through Amount 155.00
PAYROLL OUTSTANDING 2014 $
PAYROLL ADP July 1,
CHECKS Date
Issue Name
Employee Jane
Mary
Gibson
Employee Id |
Date 12/3/2014
Check
Number 22241634
Check
Maricopa County
Human Resources
Memo Se
Me
AUG i 9 205 \Y
To: Fran Mccarroll, Clerk of the Board CLERK BOARD OF SUP. 200%
From: Linda Widner
Date: August 19, 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 Linda Widner at ext. 6-8051 for any questions. Please
route approved Affidavits back to County Payroll, Suite 220.
Stale Dated Warrant Duplicate Warrant
Thank you.