STAMPED & REDACTED- LINDA SHINN.PDF

Maricopa County
Human Resources

hand gletivered Y2

sEIVED
Memo REC

APR 1-7 2025

; MARICOPA COUNTY
To: Juantia Garza, Clerk of the Board CLERK BOARD OF SUPERVISORS

From: Zell Bullis
Date: April 16,2025

Re: Replacement of Lost Payroll Warrants

Please find attached _1__ Affidavit/Notice of Claim(s) for iost

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 Zell Bullis at ext. 60409 for any questions. Please
route approved Affidavits back to County Payroll, 8" Floor.

Stale Dated Warrant Duplicate Warrant

Thank you.

Replacement Lost Warrant Form 1 08/02/2022

Application for a Duplicate or Stale-Dated Warrant/Check

Affidavit/ Claim Form

This application is for: Duplicate or 1 stale-Dated (definitions are on page 2)

STATE OF ARIZONA Note: Numbers on this form correspond to numbers on the
COUNTY OF MARICOPA Instruction sheet which is page 2 of this form.
Linda Shinn (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about 11/6/2024 (date)(2) a warrant/check was issued to the
above named person/entity in the amount as stated below. Such warrant/check was
either never received or was subsequently inadvertently lost or destroyed and there is
no reasonable probability of its being found or presented for payment, or it was not
presented for payment within one year after the date of issuance.

Therefore, under penalty of perjury, claimant hereby affirms that this claim is correct
and the amount shown is due and owing, and the applicant requests that a replacement

warrant/check be issued to him/her in the sum of $48.51 (3)
Signed: nica PSSM eS (4)

Note, Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued. : 3

(5) Subscribed and sworn to before me this ! 4th day of A p cil AT.
France sh anaovd

NOTARY PUBLIC FRANCESHANSON

My commission expires: ane i avin

(seal)

Feb nuany 23,2026

Warrant/Check Number

(if known) (6) 53019501

Original Date of Issue
(if known) (7)

11/6/2024

Reason for original issue of Warrant/Check (8):
[¥]Payroll

4/17/25
|_IFor Services or Goods furnished f =

[_]treasurer’s refund/payment
_lother:

Revised April 2015 A.RS. 11-632 & 11-644

301 W, Jafferson St. Suite 800 Phoenix, AZ 85003

Di Pay eoeriod

40/44/2024)

49.50

9,00]

0.99) 0.00

Description Dates Hours Rate Amount YTD Hours YTD Amount} |Description Amount

Cantral Board Work 10/15/2024 - 10/27/2024 3 14.5 43,50 3 43.80] [State Tax - AZ 0.99 0.99)
‘Election Incentive P10/21/2024 - 10/27/2024 3 2 6.00 3 6.00)

Eamings 49,50 49.50/ | Employee Taxes 0.93 0.99

Amount

‘Description
Federal Withholding - Taxable Wages
iState Tax Taxable Wages - AZ

49.50
49,50

Marital Status,

Allowances

0.00%

Additional Withholding

iBank

Account Name

Account Number

USD Amount

48.54

USD;

{Checid