STAMPED & REDACTED JAMES EDWARD VANHUIS.PDF

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.

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 LJ 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.
James Edward Vanhuis (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

Vs, issued to him/her in the sum of $820.00 (3)
Signed: _( 227 Yh (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 SP-Henber20 2,

NOTARY PUBLIC

WESTON BINGHAM
A, Notagy Public - State of Arizona

My commission n expires: G) MARICOPA couNTy
Ol-~O €-2026 iE expres January 04, 2028 (seal)
Warrant/Check Number
(if known) (6) 23155850
Original Date of Issue
(if known) (7) 08/17/2022
Reason for original issue of Warrant/Check (8):
Payroll
L For Services or Goods furnished rE 10/04/2022
L_Itreasurer’s refund/payment
om per UML
er:

Revised April 2015 A.R.S. 11-632 & 11-644

-Vanhuis, James Edward _ Company: MC1 Off Cycle: N
MC1 - Maricopa County Pay Group: ELE Separate Check #.0
2120 - Election Day Services _ Period End 08/07/2022 Reprint: N
ELE -Elections / Page 2342 Adjustment: N

Active 07/26/2022. Temp/PT | Line; 3

'-Vanhuis,James Edward - MC4/ELE —

( Paycheck View

Name Vanhuis,James Edward : Confirmed Check
Checkd Issue Date Earnings Taxes Deductions Net Pay
23155850 08/17/2022 320.00 : 320.00
r Regular and Overtime Earnings Taxes
Reg Hours Reg Pay. OTHours OT Pay
- OtherEarnings r Deductions
Code _ Hours Amounts Add to Gross
EPS 21.00 21.00 ¥
EPT 23.00 299.00 ¥

ADP Enterprise HR screen print as of: 09/27/2022 11:25 AM