042215 DUPLICATE WARRANT - 1.PDF

Maricopa County
Human Resources Department
Payroll & Employee
Records Division
301 West Jefferson Street
Suite 220
Phoenix, Phone: 602-506-3519 AZ 85003-2143 Memo
Payroll Fax: 602-372-0277
Records Fax: 602-506-5509
www.maricopa.gov
To: Fran McCarroll, Clerk of the Board
From: Wanda Childers
Date: April 3 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 x 6-0409 for any questions. Please
route approved Affidavits back to County Payroll, Suite 220.
Thank you.
RECERIFD
APR - 3 2 015
mARicropf. COUNTY
CLERK BOARD CA'' SUPERVISORS

APPROVED
APR 0,3 2015
AFFIDAVIT/NOTICE OF CLAIM
CLERK. BOARD OF SUPERVISORS
21 MARICOPA COUNTY
15 APR -1 RI 12t
STATE OF ARIZONA
11U11,6,1-1 RESOURCES
COUNTY OF MARICOPA
BEING FIRST DULY SWORN
OATH, DEPOSES AND SAYS:
That on the day of .491:( 1 , 20 15 , he/she presented
to Maricopa County, for payment a claim for services rendered or supplies furnished during the
month of 119arci) , said claim being in the sum of
, 0 (m_. htAncirui
Dollars ($ 0? -A ) in payment of which the Board of Supervisors caused the
Warrant No. „21010-7 3 to be issued on (.1 , 20 1,5 , 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. c-2,--)a 66731 In the sum of $ erd 7 .
,
Dated: ,20 )3 Signed: Gj -"ty,cao
PtPci
Affiant
***A $12-.00 fee for the stop payment and reissuance of the warrant will be deducted from the
replacement check***-
PATRICIA D. THOEMKE
Notary MARICOttioggyired Public - State of Arizona anp sworn to before me this 1 • 51--- day of A p / , 20 15-
My Comm rse n txpires
November 14, 2015 Pa-b,ie_L -,,,) a 4,_,-,,....,
Notary Public
My commission expires: 4--- , thoetrri 12-n+
P I
ill 1411 1.--Pb
UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO:
01/31/2013