050615 DUPLICATE WARRANTS - 1.PDF

Maricopa County
Human Resources
To: Fran McCarroll, Clerk of the Board
From: Linda Widner
Date: April 15,2015
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.
RECEIVED
APR 1.6 2015
MARIGOPA COUNTY
CLERK BOARD OF SUPERVISORS

APR 17 20
DAT
AFFIDAVIT/NOTICE OF CLAIM =| “SLERK BOARD OF SUPERVISOR:
IO APR IO PH 2: 1G
STATE OF ARIZONA
Blavdon Matthew Flonr BEING FIRST DULY SWORN
OATH, DEPOSES AND SAYS:
That on the | 5 day of A ant } ,20_) § he/she presented
,
to Maricopa County, for payment a claim for services rendered or supplies furnished during the
t
month of A Pr) | said claim being in the sum of
,
Oné Thousand One HundVéd CriZhrY aine dollavS and third’ ane cents.
Dollars ($ I, ) €4 Ile ) in payment of which the Board of Supervisors caused the
Warrant No. AAALITAS to be issued on APY?) ii ,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. 2 rA 4 72 5 In the sum of $ l, J 24 130
Dated: APri}) 1$” 20 Sianiets a2 Stace __-
,
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 _™_ is 9 day of Apr 20 iS
,
tad
My commission expires:
MARICOPA COUNTY
My Commission
November 9,