STAMPED & REDACTED - HENRY MERCADO.PDF

Maricopa County
Human Resources

Vemo

To: Juantia Garza, Clerk of the Board

pyeZ Ha LE NUE 8000

From: Zell Bullis
Date: January 31, 2025

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 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

d Warrant/Check

2 @. Duplicate OF im Stale-Dated “qennitions are on page 2}

Hats: ‘Nembers on thia fart correspond fo numbers an the
‘netruction sheet which is page: 2 af this form.

i 1. baling first swOrt, upon cath cleposes and SAYS:

ee ee “ teon0ne = féats}¢2) é. warrant/check was Issued to the

tee ae persanyentity In the amount as stated below. uch warrant/check Was

one palialiedaceee oF. was subsequently inadvertently lost or r destroyed and there {s
presented " probabiliiy of its ‘being found or presented for payraent, or if was mat
. foe payment within one year. after the date of issuance.

me oper penalty. of perjury, datmant hereby affiens that this daim ts correct
. ment shown is due and owing, anc: the applicant requests. that & Feplacement

efund/payment _ ar

W
MARICOPA
COUNTY

Human Resources
Payrall & Employee Records Division

301 W. Jefferson St., 8th Floor

Phoenix, Arizona 85003 DATE: January 31, 2025

P: 602-506-3519

F602 372-8722 TO: Kristin Storm

Maricopa.gov
FROM: = Zell Bullis

RE: Stop Payment on Warrant

Please place a stop payment on the Warrant listed below. It has been determined
that the Warrant is outstanding as of this date:

Warrant Number: 53029729

Issue Date: _ 11/20/2024

Payable to: Henry Mercado _#811125201

Amount: $429.37

Reason for Stop Payment: Employee didn’t receive PR check in the mail.

Zell Bullis

Authorized Signature — Payroll Specialist

Date Stopped Stopped by

Transaction Number Time Stopped

0,00) 0,00)

9.00) 0.00;

Description Dates Hours Rate YTD Amount

Bilingual/Premium Training 11/04/2024 - 11/10/2024 1 25 25.00 1 25.00

(Central Board Workers 10/28/2024 - 11/10/2024 24.75 14.5 358,87 31,75 460.37

Election Incentive Pay 14/04/2024 ~ 11/10/2024 22.75 2 45.50 29.75 59.50}

Earnings 423,37 544.87

&

(Description Amount YTO

Federal Withholding - Taxable Wages 429.37 544.87

Slate Tax Taxable Wages - AZ 429.37 544.87
a a ee al

arital Status. se
Allowances Q 0,00%|
[Additional Withholding of fH

Account Name

Account Number

429.37__USO}