STAMPED & REDACTED HANNAH M BONDY.PDF

Maricopa County
Human Resources

Memo

To: Juantia Garza, Clerk of the Board

From: Zell Bullis
Date: August 30, 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 you. Liparety

Replacement Lost Warrant Form 1 08/02/2022

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

This application is for: al Duplicate or CI 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.
Hannah M Bondy (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about 8/17/2022 (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 Vay sum of $451 92 .(3)
Signed: bow (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 C6" day of Aunust 2022.

(Heoty oli

NOTARY PUBLIC

My a A expires:

ZONE (seal)
Morena 6) [0023154040
Original Date oF issue 8/17/2022
Reason for original issue of Warrant/Check (8):
fl Payroll
CO For Services or Goods furnished ra
O Treasurer's refund/payment ATE 09/01/2022

O Other:

Revised April 2015 : <f U (L move

- Bondy, Hannah M _ Company: MC1
MC1 - Maricopa County Pay Group: NEX
6513- Fountain Hills Branch Period End 08/07/2022
NEX-NonExempt Page. 1049
Active 07/12/2022 Reg/PT Line: 1

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

( Paycheck View

~ Name Bondy,Hannah M : Confirmed Check
Check# Issue Date Earnings Taxes Deductions Net Pay
23154040 08/17/2022 499.20 47.28 : 451.92
- Regular and Overtime Earnings r Taxes
RegHours —_ Reg Pay OTHours OT Pay FED SSDisMLVEE 30.95
FED MedicareEE 7.23
419.50 249.60 FED Withholdng 0.11
* FED MedicareER 7.23
r OtherEarnings , Deductions
Code _ Hours Amounts Add to Gross|

ADP Enterprise HR screen print as of: 08/30/2022 10:28 AM