STAMPED & REDACTED RAJSHAAN T. MAGIC.PDF

Maricopa County
Human Resources

Memo

—
Ss
To: Juantia Garza, Clerk of the Board yes
From: Zell Bullis or
Date: September 21, 2022 ~
Re: Replacement of Lost Payroll Warrants =

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WOST

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: Duplicate or LI 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.
Rajshaan T Magic (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 $ 254-00 (3)

Signed: Rasonaan Wie a (4)

Note: Please Nee a copy of the warant/dhok if available and/or any other
evidence that a warrant/check was originally issued.

vA Subs and sworn to, before me this _\_ v = day of TESS Nes 20>,
( CinZbadrrn ty

oT . SEE, REDMOND
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Expires June 10, 2026

(seal)

Notary Public - State of Arizona
My commission expires:
— a
(if known) (6) 23155038

MARICOPA COUNTY
Warrant/Check Number
Original Date of Issue

Commission # 629162
(if known) (7) 08/17/2022

Reason for original issue of Warrant/Check (8):
Payroll

[For Services or Goods furnished |
Treasurer's refund/payment | \TE 09/22/2022

Clother: FTA —fucwtlage

Revised April 2015 14:2 Hd O2 dS e202

-Magic,Rajshaan T
MC1 - Maricopa County
2120 - Election Day Services
ELE-Elections
Active 07/26/2022 Temp/PT

Company: MC1
Pay Group: ELE

Page: 2342
Line: 1

Period End 08/07/2022

Off Cycle: N
Separate Check # 0
_ Reprint: N
Adjustment: N

Paycheck View

Name Magic,Rajshaan T Confirmed Check
Check# Issue Date Eamings — Taxes Deductions Net Pay
23155038 08/17/2022 254.00 254.00
- Regularand Overtime Earnings: Taxes
Reg Hours Reg Pay OT Hours OT Pay
- OtherEarnings | ~ Deductions
Code ~ Hours Amounts Add to.Gross| :
- EPS 13.50 13.50 ¥
| EPT- 18.50 240.50 Y

ADP Enterprise HR screen print as of: 09/21/2022 10:58 AM