STAMPED & REDACTED ERICK FAVELA HERRERA.PDF

Maricopa County
Human Resources

Memo

To: Juanita Garza, Clerk of the Board

. OCT 18 2022
From: Sonny Villacorta ao
CLERK eT COFA CO ITY
Date: October 12, 2022 VESTS BOARD OF SUPERVISORS

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 Sonny at ext. 63756 for any questions. Please route
approved Affidavits back to County Payroll, Suite 800.

Stale Dated Warrant

Duplicate Warrant

Thank you.

Replacement Lost Warrant Form 1 02/25/2015

BMY YI

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form

This application is for: ra Duplicate or CO 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.

Erick Favela Hewera (1), being first sworn, upon oath deposes and says:
Name/Claimant

On or about 07 /o4 /202Z (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 $_Qa4. 12 (3)

Signed: tooth bene (4)

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

rea cribed and sworn to before me this_ AZ~day of Octi@he 20°22

NOTARY PUBLIC oS

RENEE M HERNANDEZ
Notary Public
issi i : Commission Number 633037
ly com. D7 expires: Expires: August 20, 2026
Maricopa County (seal)

Warrant/Check Number 73 \boZ0 92. |

(if known) (6)
Original Date of Issue

(if known) (7) 09/14 (2022

10/14/2022
~~ Reason for original issue of Warrant/Check (8): ~ z /14/
{A Payroll
OO For Services or Goods furnished

QO) Treasurer’s refund/payment
OO Other:

Brup Ck WEP A202

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

Dif. 22
Transnltn + | dlleD1O7

Updated 02/10/2022

432 Srnar(Compliance’

Home Processes

Management & Reversals

Look up the detoils of a single payment ot range of payments by using the forin below.
NOTE: The maximum check range is liled to 80 checks per request.

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“BRANCH COMPANY CODE.

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SORTBY: NAME

STATUS: ALL ¥ Semen Qa

faa] Herrera Erick F ES # 23162092 th #xKoow

$22A33 issued on 09/14/2022

UnpaidUncashed