STAMPED & REDACTED RASHID JOHNSON.PDF
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Maricopa County Human Resources “Hy Lt S Baa Memo To: Cindy Goelz, Clerk of the Board From: Zell Bullis Date: July 12, 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, Suite 400. Stale Dated Warrant Duplicate Warrant Thank you. Replacement Lost Warrant Form 1 04/08/2021 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: Duplicate or L] 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. Rashid Johnson (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 6/22/2022 (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 Signed: f (4) Note. Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. aa be issued to him/her in the sum of $6800 aR OWAS! (3) (5) Subscribed and sworn to before me this__!! __day of July 20a) . NOTARY PUBLIC EILEEN WILLIAMS-PREAS — . Notary Public - State of Arizona My commission expires: MARICOPA COUNTY 1§}-Q—90aa Expires Novernber 8, 2022 (seal) Warrant/Check Number (if known) (6) 23140480 Original Date of Issue (if known) (7) 6/22/2022 Reason for original issue of Warrant/Check (8): Payroll L_IFor Services or Goods furnished DATE 07/20/2022 treasurer's refund/payment . Ud ar Llother: af 1H ne Revised April 2015 -* Uo 14g) UO Medowe (t b ARS, 11-632 & 11-644 Phoeniiy AZ % 20> WHER - HOOD - Johnson,Rashid S _ Company: MC1 MC71 - Maricopa County _ PayGroup: NEX 2170 -Recruitment and Training _ Period End 06/12/2022 NEX-NonExempt Page 239 Active 06/06/2022 Temp/PT | Line: 4 Off Cycle: N Separate Check # 0 Reprint: N Adjustment: N ( Paycheck View Code Hours Amounts Add to Gross Name Johnson,Rashid S Confirmed Check Check# Issue Date Earnings Taxes Deductions Net Pay 23140480 06/22/2022 666.00 105.72 560.28 - Regularand Overtime Earnings 7 Taxes Reg Hours Reg Pay OTHours OT Pay FED — SSDisMLVEE 41.29 FED MedicareEE 9.66 37.00 666.00 FED Withholdng 36.79 * FED SS/Dis ER 41.29 + FED MedicareER 9.66 r OtherEarnings Deductions ADP Enterprise HR screen print as of: 07/12/2022 12:28 PM