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20/347.13 _, Maricopa County General Government 2:53 Memo To: Fran McCarroll, Clerk of the Board From: Wanda Childers Date: August 6, 2013 Re: Replacement of Lost Payroll Warrants - S-fale 1)04-so! 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. AFFIDAVIT/NOTICE OF CLAIM STATE OF ARIZONA 20131131 AM 8: I 7 COUNTY OF MARICOPA MARIC014, COUNTY DEPT. OF ELECTIONS DEBBRA TUCKER _ BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on the 15TH day of MAY ,20 13 , 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 *T) ,Z3 Dollars ($ 100.00 ) in payment of which the Board of Supervisors caused the 31' 4") Warrant No. 21926223 to be issued on NOVEMBER 23 , 20 11 , drawn•on &El —0 Payroll Clearing Account fund. 119 o Affiant further says that although he/she was informed and believes that the above mer nec 0.0 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. 21926223' In the sum of $ 100.00 Dated: /1 a ,20 Signed: 1-)1, Affiant ***A $12.00 fee for the stop payment and reissuance of the warrant wffi be deducted from the replacement check.*** Subscribed and and sworn to before me this 41 j I -.."—day of 17414 , 20 n. Notary Public My commission expires: .17-""46--"ItgrLEE EHMKE Publle Mita of Mums 12 • lq-206 --- • Commicsion PINAL COUNTY Oxplas UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TOI Mambo' 14, 2015 Name: .043B/C4 -72-1eAWr Telephone Number: Address:11.111.011111 1 ployee ID #: Address: 01/31/2013