5 DUPLICATE WARRANTS - PAYROLL.PDF

Maricopa County
Human Resources
Memo
To: Fran McCarroll, Clerk of the Board
From: Linda Greinke
Date: March 25, 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 at ext. 63770 for any questions. Please route
approved Affidavits back to County Payroll, Suite 220.
Stale Dated Warrant Duplicate Warrant
Thank you.
RECEIVED
Replacement Lost Warrant Form 1 MAR 2 5 2015 02/25/2015
MAR1COPA COUNTY
CLERK BOARD OF SUPERVISORS

AFFIDAVIT/NOTICE OF CLAIM i if( BOARD OF SUPERVISORS
MARICOPA COUNTY
r-
STATE OF ARIZONA 1510 24
COUNTY OF MARICOPA HUllAt-! RESOURCES
Laura Perry BEING FIRST DULY SWORN
OATH, DEPOSES AND SAYS:
That on the R.20 h day of rG , 20 he/she presented
to Maricopa County, for payment a claim for services rendered or supplies furnished during the
month of e.., tk—fA,L et-u-i-j- A 0 / e - , said claim being in the sum of
Two-hundred twentk-eight and 35/100
Dollars ($ 228.35 ) in payment of which the Board of Supervisors caused the
Warrant No. 250000488 to be issued on 2/26 20_15 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. 250000488 In the sum of 228.35
20__ ,
Dated: 02/26 15_ Signed: _A,d/j,(4_.
Affiant
*** Eleft-FeINStillitee^€ warrant will be deducted from the
replacement check.***
Subscribed and sworn to before me this 2v 'day
Hilaire Minsosse Kounouho
My commission expires: Notary Public
(01-/— — pe-o/7 Maricopa County, Arizona
UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO: My Comm, Expires 04-03-17
A
01/31/2013