STAMPED & REDACTED LEONARD KRUPNIK.PDF
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Maricopa County Human Resources Memo To: Juanita Garza, Clerk of the Board From: Monica Reyes Date: October 13, 2022 Re: Replacement of Lost Payroll Warrants ‘© Hd €1 190 2202 G&G ZF PRRMMapaLy — “ot 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” ————S—sS«é@Dplicate Warrant” [ Thank you. Replacement Lost Warrant Form 1 02/25/2015 Application for a Duplicate or Stale-Dated Warrant/ Check Affidavit/Claim Form This application is for: IM Duplicate or C1 state-Dated (definitions are on page 2) STATE OF ARIZONA Note: Numbers on this form correspond fo numbers on the COUNTY OF MARICOPA Instruction sheet which is page 2 of this form. LEON AND Li a yok (1), being first sworn, upon oath deposes and says: “Name/Claimant ~ On or about 4 2€ ZZ (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. a 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 $ 3 1G. 8dmX (3) sent An LEB US (4) a Note: Please attach a ‘he warrant/check if available and/or any other evidence that. 4 warparit/check was oxiginally issued. sworn to before me this rine day of la ofp bey 20 2) (5) Subscriped a ——._| ave Vo ae My commission ires: JENNADY ORENDAIN Notary Public - Arizona Maricopa County = Commission # 5981 ee os ‘ ae My Commission Expires February 9} Warrant/Check Number (if known) (6) 23165241 Original Date of Issue (if known) (7) 09/28/2022 Reasgn for original issue of Warrant/Check (8): Payroll O For Services or Goods furnished 10/14/2022 1 Treasurer’s refund/payment OO Other: Revised April 2015 Name Krupnik,Leonard Ervin Confirmed Check Check# Issue Date Earnings Taxes Deductions Net Pay 23165241 09/28/2022 333.84 14.02 319.82 r Regular and Overtime Earnings » Taxes Reg Hours Reg Pay OT Hours OT Pay Z——Withholdng 44-62 - Other Earnings r Deductions Code _ Hours Amounts Add to Gross HPR 333.84 Y ADP Enterprise HR screen print as of: 10/13/2022 07:36 AM