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Maricopa County Human Resources Memo To: Fran McCarroll, Clerk of the Board From: Linda Widner Date: March 30, 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 Thank you. RECEIVED MAR 3 0 2015 MARIC01- '1-I COWIN CLERK BOARD OF SUPERVISORS 'PROVED ;_. AFFIDAVIT/NOTICE OF CLAIM VARICOPA COUNTY STATE OF ARIZONA COUNTY OF MARICOPA rFt og c-e.1 RelenGlo BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on the day of Vlikr0/1 , 20 , he he presented to Maricopa County, for payment a claim for services rendered or supplies furnished durin g the month or 5 , said clahn being in the sum of a < `i../ • Dollars ( ) in payment of which the Board of Supervisors caused the Warrant No. 0 IQ issued on '')]2-G b , drawn on the Payroll Clearin g Account fund. A ffiant further sa ys that although he/she was informed and believes that the above mentioned warrant was re gularly issued, the same has never been received, or has been lost, Under penalt y of pcjury, affiant hereby affirms that this claim is correct and the amount shown is due and owin g. WHEREFORE, afflant re quests that the Board of Supervisors issue to him/her a duplicate of said Vs/arrant No. ADOD /414 (el 0 In the sum of $ Dated: fiVOZAA 0 , 20 IS Signd Affiant 1iA-$1-2,0-0-fee for the-stop-pnymen-t-ford-reissumfee-of the-wit rrnot-13411-be-ilefluctetf from the rep1ueoluentellee1011-* Subscribed and sworn to before me this 30&da y of Ptilvcir. , 20 )5 &AL r\-- Natal), Public .— • • My commission expires: TYRONE A. MAYBERRY Notary Public Anions [955 /1 Madcap. County UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO: My Comm. Explros Jul 26, 2015