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Maricopa County
Human Resources
Memo
To: Fran McCarroll, Clerk of the Board
From: Linda Widner
Date: March 18, 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
MAR 18 2015
MARICOPA COUNTY
CLERK BOA®D OF SUPERVISORS ;
AFFIDAVIT/NOTICE OF CLAIM
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STATE OF ARIZONA
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~The,
COUNTY OF MARICOPA HUMAN RESOURCES
al £4
b ats sa. 4) Sar BEING FIRST DULY SWORN
OATH, DEPOSES AND SAYS:
That on the } K' day of VN 5 ee lL. ,20_)S5_, he/she presented
to Maricopa County, for payment a claim for services rendered or supplies furnished during the
month of Fehr UAart said claim being in the sum of
y ,
= ve Hone red aac} iv, nety Ei Lt Delle {S$ poet Twenty Ninecerls
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Dollars ($ Set f 4 2 5 ) in payment of which the Board of Supervisors caused the
Warrant No. 7 2260794 tobe issued on Februa 25,20 [5 _, drawn on the
ry
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.22 26 © '7 4 J In the sum of $ $9 §.-29
3-13 js dee. Lb) kh
Dated: , 20 Signed:
Affiant
*** A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the
replacement check.***
Subscribed gnd sworn to before me this 4 day of We-<f- 20 [ 5
,
[satin i gE BORTIAM. .- LOMAX _
| Sfecsemves . Notary e Publle - Stato of Arizona OTe & A a Cane
Hee MARIGORA COUNTY ‘
POR B( iviy Commission Expires Notary Public
Mydémmission epee
UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO: