042215 DUPLICATE WARRANT - 2.PDF

DOA RD OF CLERK SUPER VISOR'S
PIARICOPA COIJigT Y Maricopa County
2015 APR -6 PI1 I: 48 Human Resources
Memo
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 ext. 60409 for any questions. Please route
approved Affidavits back to County Payroll, Suite 220.
Stale Dated Warrant Duplicate Warrant )
Thank you.
Repfacement Lost Warrant Form 1 02/25/2015

APPROVED
DATE _ B10
K DCARD OF SUP
AFFIDAVIT/NOTICE OF CLAIM MARICOPA COUNTv
15 APR —2 PM 12: 55
STATE OF ARIZONA
HUMAN RESOURCES
COUNTY OF MARICOPA
ROBERT J HOLMES BEING FIRST DULY SWORN
OATH, DEPOSES AND SAYS:
That on the 4TH day of NOVEMBER , 20 14 , he/she presented
to Maricopa County, for payment a claim for services rendered or supplies furnished during the
month of NOVEMBER , said claim being in the sum of
ONE HUNDRED FIFTEEN and 00/100
Dollars ($ 115.00 ) in payment of which the Board of Supervisors caused the
Warrant No. 22239787 to be issued on DECEMBER 3 , 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. 22239787 In the sum of $ 115.00
Dated: I VI C r c, 'I,3 , 20 I S Signed 71-
Affiant
replacement elteekek
3tot /i rJ
Subscribed and sworn to before me this ' day of , 20
Notary Publid
My commission expires: SHAWN T. FOX
Notary Public
oi/v/aoiS Mancopa County, Arizona
My Comm. Expires 094348
UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO: