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Maricopa County Human Resources Department Payroll & Employee Records Division 301 West Jefferson Street Suite 220 Phoenix, AZ 85003-2143 Phone: Payroll 602-506-3519 Fax: 602-372-0277 Memo Records Fax: 602-506-5509 www.maricopa.gov To: Fran McCarroll, Clerk of the Board From: Wanda Childers Date: March 13, 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. RECE IFD MAR 1 3 ?015 mARIcom COUNTY CLERK BOARD OF SUPERVISORS OVED MARA 3 2015 AFFIDAVIT/NOTICE OF CLAIM RK BOARD OF SUPERVISORS MARICOPA COUNTY STATE OF ARIZONA 15 MAR 13 A;i 10: Fr' COUNTY OF MARICOPA HUMAN RESOURCES Uf3(f_ BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on the 3 6'( day of a <LC , 20 \ he/she presented to Maricopa County, for payment a claim for services rendered or supplies furnished during the month of (J\6 (to . , said claim being in the sum of n Ver 0 h c Dollars ($ S1,4, ) in payment of which the Board of Supervisors caused the Wanant No. 001:2-7-- 6(:;to be issued on HA rt c ,20 I , 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.001:7-`7-c .77 In the sum of $ Dated: i\i\e/I -22 ,20 Signed: Affiant ***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the replacement check.*** Subscribed and sworn to befoie me ..otar37Public LUCIA M. TAMK My commission expires: Notary Public - Stale of Patone MARICOPA COMM 'lvi -? commission Expires ; ACEMENT CHECK TO: MaY 2 2°17 01/31/2013