STAMPED & REDACTED - GRANT BELL.PDF

Maricopa County
Human Resources

Memo

Tor Juanita Garza, Clerk of the Board
From: Monica Reyes
Date: February 5, 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 Monica at ext. 68051 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 02/25/2015

wa

ch paanime puroy

Application for a Duplicate or Stale-Dated Warrant/Check

Affidavit/Claim Form COUN,
as
This application is for: KX Duplicate or Stale-Dated (definitions are on page 2)
STATE OF ARIZONA Nolte; Numbers on this form correspond to numbers on the
COUNTY OF MARICOPA Instruction sheet which is page 2 of this form.
nahn Bet! (1), being first sworn, upon oath deposes and says:
On or about _ Jen 28 22S (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 ammount shown is due and owing, and the applicant requests that a replacement

warrant/check be issued to him/her in the sum of $ &,066.15 (3)
Signed: Srewk- BEET (4)

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

(5) Subscribed and sworn to before me this Buel day of Felovary 20aS.
QM a

a

Nolary Publle State of Arizone

sshtoy Ni sie Feulkner =
tot el ala Expires 12/1 112027

Commission Number 660840

NOTARY PUBLIC

My commission expires:
aj [A0a>

Warrant/Check Number | S20-)-
‘koa (6) 301206]

Original Date of Issue
’ (if known) (7) Tan 22 2625

Reason for original issue of Warrant/Check (8):
& Payroll

© For Services or Goods furnished
Treasurer's refund/payment __
C1 Other: : J

Revised April 2015 632 && 11-644

Maricopa County 301 W. Jefferson Sti. Suite 800 Phoenix, AZ 86003

+1 (602) 5063519

Account Name

Bank

“Peetian Dede Cc ea
; 0.00) 464.85) 0.00} 2,066.15
YTD 86.00 2,551.00} 9,00] 484.85) 0.00 2,066.15)
Dates Hours Rate Amount YTD Hours YTD Amount] [Description Amount
[Admin Leave With #01/13/2025 - 01/19/2025 2 3 62,00 2 62.00] ;OASDI 158,16
Regular Pay 01/06/2025 - 01/19/2025 80 3 2,480.00 ao 2,480.00] jMedicare 36.99
Shift Differential ThiO1/06/2025 - 01/19/2025 4 0.75 3,00 4 3.00] jFederal Withholding 238.68
Shift Differential Tw01/06/2025 - 01/19/2025 12 0.5 6.00 12 6.00] jState Tax - AZ $4.02
Earnings 2,551.00 2,551.00] | Employee Taxes 484.85
pe
Description
IOASOI - Taxable Wages 2,551.00 2,551.00
Medicare - Yaxable Wages 2,654.00 2,551.00
Federal Withholding - Taxable Wages 2,551.00 2,551.00
State Tax Taxable Wages - AZ 2,551.00 2,551.00
Marital Status Single or Married filing ‘Description Reduced Available’
separately! Floating Personal Day 8 0 8
Nowances oO 0.00% {Sick - County 274 0 2.74
|Additianat Withhoiding 0 acation ~ County 4.65 0 4.65
SEEMS

iinet eines

Amou

int

(Check)

2,068.15

USD

; Stop Check

@ Checks) stap request has. been successfully submitted: |

Successful checks - 1

Check Number Pay Date Employee Name Amount

0000053072867 01/29/2025 Bell,Grant M $2066.15 Your stop payment request has been
submitted, If successful, this
transaction will not adjust employee
YTD wages in your payroll system.
Adjust your payroll system if this stop
payment affects employee YTD
wages.

Thank you!

Kristin Storm

HUMAN RESOURCES
301 W Jefferson, 8° Floor Phoenix, AZ 85003

MA RI COPA Pavol! Accountant
COUNTY O: 602-506-6688

MARICOPA.GOV
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From: Monica Reyes (MHR) <Monica.Reyes@Maricopa.Gov>
Sent: Monday, February 3, 2025 3:48 PM

To: Kristin Storm (MHR) <kristin.storm@maricopa.gov>
Subject: Grant Bell/811156119 - Stop Payment

Hi Kristin,

Could you please put a stop payment on this check:
Name: Grant Bell

Net Amount: $2,066.15

Check date: 1/29/25

Thank you,