STAMPED & REDACTED ALAN G AVERSA.PDF

Maricopa County
Human Resources

Memo

To: Juantia Garza, Clerk of the Board

From: Zell Bullis
Date: August 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

Thank you.
RECEIVED

AUG 69 2027

MARICC# ry
Replacement Lost Warrant Form 1 CLERK BOARD OFS SPERvis on e222 ngs”

Ho Dowd - ft

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

This application is for: |] 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.
Alan G Aversa (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about o7/06/2022 (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 $225.93 (3)

Signed: cw WN (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) ee i to before me this = day of uguce 20, Ce

—

Me al _
NOFARY PUBLIC
a ; JOE ANTHONY GARDNER
My commission expires: we Bean ones
Wy fo {Vers i] Commission # 617830 (seal)

My Comm, Expires Oct 6, 2025

Warrant/Check Number ;

(if known) (6) 23143395 ;
Original Date of Issue

(if known) (7) _ 07/06/2022

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

CI For Services or Goods furnished

[_Itreasurer’s refu nd/payment ’ F "

(_lother:

ATE 08/09/2022

Revised April 2015 fe U dL KW daly a

- Aversa,Alan G
MC1 - Maricopa County

2140 - Early Voting Services
NEX-NonExempt
Active

Company: MC1
Pay Group: NEX

Period End 06/26/2022

Page. 223
Lines 6

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

06/21/2022 Temp/PT

( Paycheck View

Name Aversa,Alan G Confirmed Check
Check# Issue Date Earnings Taxes Deductions Net Pay
23143395 07/06/2022 252.00 26.07 225.93
- Regularand Overtime Earnings - Taxes
RegHours —_ Reg Pay OT Hours OT Pay FED SSDisMLVEE 15.62
FED MedicareEE © 3.65
48.00 252.00 * FED SS/Dis ER 15.62
* FED MedicareER 3.65
AZ Withholdng 6.80
r OtherEarnings r Deductions
Code _ Hours Amounts Add to Gross

ADP Enterprise HR screen print as of: 08/08/2022 01:24 PM