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Maricopa County
Human Resources
Viemo
To: Fran McCarroll, Clerk of the Board
From: Linda Widner
Date: May 21,2015
Re: Replacement of Lost Payroll Warrants
Please find attached 1___Atffidavit/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.
RECEIVED
12 AWW SIO MAY 9,4 2015
ag: Hd
ALRNOD V 001d Tog CLERK BOARD OF SUPERVISORS
\AdaaNs J8
peony aly
AFFIDAVIT/NOTICE OF CLAIM
STATE OF ARIZONA
COUNTY OF MARICOPA
—~
BEING FIRST DULY SWORN
OATH, DEPOSES AND SAYS:
That on the _\\ YO\\___ day of A\" 20_\ “>, he/she presented
,
to Maricopa County, for payment a claim for services rendered or supplies furnished during the
month of = KA CQ\A said claim being in the sum of
,
ive. Wn LASC Qa ONE Hund LA
Dollars ($ — , \“44 GO __)in payment of which the Board of Supervisors caused the
Warrant No. C01 $083. to be issued on 20 \ drawn on the
, ,
Payroll Clearing Account fund.
Affiant 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. Under penalty of
perjury, affiant hereby affirms that this claim is correct and the amount shown is due and owing.
WHEREFORE, affiant requests that the Board of Supervisors issue to him/her a duplicate of said
Warrant No, —)QO0C Loc D2 Inthe sum of $
\
e
an
Dated: 2 | Q\ aS), 20S Signed:
Affiant
*** A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the
replacement check.***
Subscribed and sworn to before me this _©' a day of Muy 205
Ps
Bw WUD bum
~ Notar
&
My commission expires: \\-C\ 1OVG
MARICOPA COUNTY
My Commission
November 9, 20
_ Maricopa County
Human Resources
Viemo
To: Fran McCarroll, Clerk of the Board
From: Linda Widner
Date: May 19, 2015
Re: Replacement of Lost Payroll Warrants
Please find attached 1__ Affidavit/Notice of Claim(s) for lost
payroll warrants for inclusion on the next available Board agenda.
The attached item(s) have been researched to ensure that the
warrant(s) in question have not been cashed or previously re-
issued. The original warrant(s) have had a stop payment done.
Please call Linda Widner at ext. 6-8051 for any questions. Please
route approved Affidavits back to County Payroll, Suite 220.
Stale Dated Warrant Dua Warrant
Thank you.
RECEIVED
MAY 20 2915
MARIGOPA COLINTY
CLERK BOARD OF SUPERVISORS
inTeR office =U G
AFFIDAVIT/NOTICE OF CLAIM
STATE OF ARIZONA
(15 WAY 19 P 206
COUNTY OF MARICOPA
,
MARICOPA COUNTY
PAYROLL /RECORDS
EZic LwiLlLiawnss BEING FIRST DULY SWORN
OATH, DEPOSES AND SAYS:
That on the | Or day of May 20 \‘5_, he/she presented
to Maricopa County, for payment a claim for services rendered or supplies furnished during the
month of CFA said claim being in the sum of
ay ,
Poo
Touc hundred ond nine DoliaxS
seventy
Dollars ($ C7) a, 18 ) in payment of which the Board of Supervisors caused the
Warrant No. 22215970 to be issued on OS/Olo ,20 14 drawn on the
,
Payroll Clearing Account fund.
Affiant 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. Under penalty of
perjury, affiant hereby affirms that this claim is correct and the amount shown is due and owing.
WHEREFORE, affiant requests that the Board of Supervisors issue to him/her a duplicate of said
Warrant No. ZZZ159% \U In the sum of $Y 19.1%
Dated: oy | 20 \5_ Signed: = ae
Affiant
***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the
replacement check.*** ;
Subscribed and sworn to before me this 1 day of WWW, 201 $
__,
7 ML
Or he MW Wet
PORTIAM. LOMAX-
%,
sotnry Public. State of Arizona {Notary Public
My commission MARIGOPA COUNTY
My Commission Expres
dune 16, 2017