STAMPED & REDACTED PHYLLIS DOLORES LEWIS.PDF
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Maricopa County Human Resources Memo To: Juantia Garza, Clerk of the Board From: Zell Bullis Date: September 29, 2022 Re: Replacement of Lost Payroll Warrants Please find attached _ 1 Affidavit/Notice of Clairm(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. RECEIVED SEP 29 2022 MARICCPA COUNTY CLERK BOARD OF SUPERVISORS Replacement Lost Warrant Form 1 I | ped ~ ppm Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/ Claim Form . This application is for: Duplicate or L 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. Phyllis Dolores Lewis (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 08/17/2022 (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 $365.50 (3) Signed: PhacQu em §.) spe pO 5 (4) Note. eee ate 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 _&¢@¢" Way of Septembe c 2022 Prone. Howaed NOTARY PUBLIC ) My commission expires: Oy Commiation #624062 Eebrvary 23, 202 ae Warrant/Check Number (if known) (6) 23154970 Original Date of Issue (if. known) (7) 08/17/2022 .Reason for original issue of Warrant/Check (8): Payroll [_]For Services or Goods furnished L_Itreasurer’s refund/payment - 10/04/2022 _lother: Suntan Revised April 2015 - Lewis,Phyllis Dolores MC1 - Maricopa County 2120 - Election Day Services ELE-Elections Active 05/17/2016 Temp/PT Company: MC1 Pay Group: ELE Period End 08/07/2022 Page: 1220 Line: 3 Off Cycle: N Separate Check # 0 Reprint: N Adjustment: N ~ =Lewis,Phyllis Dolores-MC1/ELE ( Paycheck View Name Lewis,Phyllis Dolores Confirmed Check Checkd Issue Date Earnings Taxes Deductions Net Pay 23154970 08/17/2022 365.50 365.50 - Regular and Overtime Earnings ; Taxes Reg Hours Reg Pay OTHours OT Pay - OtherEarnings r Deductions Code __ Hours Amounts Add to Gross EPS 22.50 22.50 Y ETO 24.50 343.00 Y ADP Enterprise HR screen print as of: 09/27/2022 11:24 AM