STAMPED & REDACTED CHRISTINE A HARTMAN.PDF

Maricopa County
Human Resources

Memo

To: Juantia Garza, Clerk of the Board

From: Zell Bullis
Date: September 8, 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

toed Dolucd -fE

RECEIVED

Thank you.
SEP ~ 8 2022
MARICOPA COUNT Y
CLERK BOARD OF SUPERVISORS
Replacement Lost Warrant Form 4 08/02/2022

ne
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Application for a Duplicate or Stale-Dated Warrant/Check

Affidavit/Claim Form

This application is for: Duplicate or C] 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.
Christine A Hartman (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about o8/o3/2022 (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 $842.50 (3)

Signed: Minahig Ub. Wein (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__2. day of Se ptenber 202).

yApt-

NOTARY PUBLIC

My commission expires:
Mev a, dort’

Warrant/Check Number | HW
(if known) (6) 23151224

Original Date of Issue
(if known) (7) 08/03/2022

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

[ror Services or Goods furnished

LItreasurer’s refund/payment S 09/09/2022
Clother:

Auanit ap

MC1 - Maricopa County
2120 - Election Day Services

- Hartman,Christine A

Company: MC1
Pay Group: ELE
Period End 07/24/2022

Off Cycle: N
Separate Check # 0
Reprint: N

ELE-Elections Page: 2296 Adjustment; N
Active 07/42/2022 Temp/PT Line: 6

( Paycheck View

Name Hartman,Christine A Confirmed Check
Check# Issue Date Earnings Taxes Deductions Net Pay -
23151224 08/03/2022 342.50 342.50
- Regularand Overtime Earnings ~ Taxes
Reg Hours Reg Pay OT Hours OT Pay
- OtherEarnings - Deductions
Code __ Hours Amounts Add to Gross
_EPT 24.75 39175 AY.
EPS 20.75 20.75 Y.

ADP Enterprise HR screen print as of: 09/08/2022 01:18 PM