STAMPED & REDACTED LAURA JOAN WILLIAMS.PDF

Maricopa County
Human Resources

Memo

To: Juantia Garza, Clerk of the Board

From: Zell Bullis
Date: September 7, 2022

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 Zell Bullis at ext. 60409 for any questions. Please
route approved Affidavits back to County Payroll, 8" Floor.

Stale Dated Warrant Duplicate Warrant
Thank ou SEP - 7 2022
RICOPA SOUNTY
CLERICBOARD OF SUPERVISORS

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 C1 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.
Laura Joan Williams (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about 08/03/2022 (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 $ 364.50 (3)

Sioned faite YD Lae (4)
Oi

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

__(6) Subscribed ny ee to befgre me this \ day off 2) vl QW ih DOG SZ
—

NOTARY sa) ease

DAWN MOYNIHAN
My Wa cceee ex, ies: commission # 870126
Lor\ pres Ooeoel™. (seal)
Warrant/Check Number
(if known) (6) 23151669
Original Date of Issue
(if known) (7) 08/03/2022

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

[_]For Services or Goods furnished__
(Treasurer's refund/payment

[_Jother: NATE An

Revised April 2015 af! ACM Atal a) AC

-Williams,Laura Joan
MC1 - Maricopa County
| 2120 - Election Day Services
ELE-Elections
41/02/2010. Temp/PT

i

— Active

Company: MC1
Pay Group: ELE

Period End 07/24/2022

Page: 2215
Line: 4

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

é Paycheck View

Name Williams,Laura Joan Confirmed Check
Check# Issue Date Earnings Taxes Deductions Net Pay
23151669 08/03/2022 364.50 364.50
r Regularand Overtime Earnings r Taxes
Reg Hours Reg Pay OT Hours OT Pay
- OtherEarnings . ¢ Deductions
Code Hours Amounts Add to Gross|
EPS 21.50 21.50 Y
ETO 24.50 343.00 XY.

ADP Enterprise HR screen print as of: 09/07/2022 07:29 AM