STAMPED & REDACTED - TERRY PREISS_52952202.PDF
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Naricopa County Human Resources Memo aie Juantia Garza, Clerk of the Board From: Zell Bullis Date: January 23, 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 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: FA} Duplicate or C1 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. Terry Preiss i é ob Aa (1), being first sworn, upon oath deposes and says: On or about 713112024 (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 $301.88 (3) Signed: Jenn Pwr (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 2 day of January 20 25, TAL DBM NOTARY PUBLIC Ashlee J Ganilia Notary Public My commission expires: © My Corr. Expos 02-26-28 02 | Le) 202¥ Commission No, 663732 (seal) Warrant/Check Number (if known) (6) 52952202 Original Date of Issue (if known) (7) 7/31/2024 Reason for original issue of Warrant/Check (8): [¥] Payroll (_]For Services or Goods furnished [_Itreasurer’s refund/payment other: y 1/24/25 Revised April 2015 co 000302-000302 89V 2120 Maricopa Counly 301 W. Jefferson St. Suite 800 Phoenix, AZ 85003 For inquiries on this statement please call: 602-506-3519 -00 Total Hours Worked: Basis of Pay: Hourly Pay Rate; 12.15 Hours/ This Earnings Rate Units Period Year-to-Date Central Boar 14,5000 20.25 293.62 2174.99 Election Inc 2.0000 40.50 40.50 Central Boar 0.00 +20 Earnings Statement Employee ID 811145712 Page 001 of 001 Period Beg/End: 07/08/2024 - 07/21/2024 Check Date: 07/31/2024 LINE. 7 Check Number: 0052952202 Batch Number: SCR7WYJTRT25 | ET Lt} Terry Preiss 2 DAN 995 E Baseline Rd #2048 : Tempe, AZ 85283 This Period Other Deductions Year-to-Date Taxes Medicare 4.85 37.57 OASDI 20.71 160.62 Your Federal taxable wages for this period are: $334,12 DECUVENTAUTHENT Ca ee G LOBED ATEN W DST mcH pW CEs i MIE Maricopa County 301 W. Jefferson St. Suite 800 Phoenix, AZ 85003 PAU UALS AiO) = *Excluded from taxable wages ©2017 ADP, LLC (PCSUCH) SNEY eHOM OANrLS WTOP To Uleer ese 4 90-477/1222 CA Check Number: 0052952202 Check Date: 07/31/2024 aE ONT ON) NC All Rights Reserved. rs Fs < g oS & 3 3 This amount: “THREE-HUNDRED ONE DOLLARS AND 88/100: | = $7301.88 | Pay to the Terry Preiss order of: ASSISTANCE WITH VERIFICATION AVAILABLE AT 877-423-7243 Void after 180 days ‘ADP AUTHORIZED SIGNATURE THE OAIGINAL pOCU L279 View WEN CHACKING Te SNVOHSEMENT