052015 DUPLICATE WARRANTS - 4.PDF

OF SUPERVISOR'S
ARRICOPA COUNTY Naricona Golnty
VA PM I: 17 Human Resources
ois MAY
VMemo
To: Fran McCarroll, Clerk of the Board
From: Linda Widner
Date: May 11, 2015
Re: Replacement of Lost Payroll Warrants
Please find attached _1 _ Affidavit/Notice of Claim(s) for lost
ees
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 W. at ext. 68051 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

AFFIDAVIT/NOTICE OF CLAIM
RECEIVED
STATE OF ARIZONA
Y
e, MARICOPA. a
es
“Trina BEING FREAYR AY SiGe
A. HAP
OATH, DEPOSES AND SAYS:
That on the \ dayof _\V 20 [25 | he/she presented
1a ,
to Maricopa County, for payment a claim for services rendered or supplies furnished during the
month of (\ XY Ne said claim being in the sum of
,
VES \t Nee elma | 0 { od Clo\lar + (O4+4 Col i=
MH
Dollars ($ [2 oot ol Y _) in payment of which the Board of Supervisors caused the
Warrant No. ~/ a 2/0 to be issued on _“D i CGLACT ,20 “<> _, drawn on the
7 V4
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. Ap Y o- 5 In the sum oR x, C : Pot A
=e
ae
&, OG
Dated: 5 le UE a tS Sighed: a
,
~
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 _‘' \t day of May ,20.\ 5
x
Fue WL
Notary Public
Not
My commission expires: \W-Q “20S MARICOPA COUNTY
November 9, 2018