STAMPED & REDACTED JOSHUA LYONS.PDF

Maricopa County
Human Resources

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Mn Deliud

Memo

To: Juanita Garza, Clerk of the Board
From: Monica Reyes n>
Date: April 22, 2022

Re: Replacement of Lost Payroll Warrants cn

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 Monica at ext. 68051 for any questions. Please route
approved Affidavits back to County Payroll, Suite 400.

Stale Dated Warrant Duplicate Warrant

Thank you. we

Replacement Lost Warrant Form 1 02/25/2015

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

This application is for: RI 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.
Joshua Lyons (1), being first sworn, upon oath deposes and says:

Name/Claimant *

On or about _Ou | (2 lzo2z (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

yis4s “DY

warrant/check be issued to him/her in the sum of $

Signed: aL S223 (4)

e. pee étach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.

(3)

(5) Subscribed and sworn to before me this ual day of Apo / 2000.
—

NOTARY PUBLIC

> GINO JAUREGUI
d Ca Notary Public - Arizona

My commission expires:

ita iB Maricopa County
Warrant/Check Number -22\2S|&l
(if known) (6)
Original Date of Issue
(if known) (7) 4 [13 ae
Reasi iginal issue of Warrant/Check (8):
4a Payro
0 For Services or Goods furnished 04/22/2022

O Treasurer’s refund/payment
x Other: Unitrernr cllowance

Revised April 2015 A.R.S, 11-632 & 11-644

( Paycheck View

Name Lyons,Joshua G Confirmed Check
Check# Issue Date Earnings Taxes Deductions Net Pay
23125166 04/13/2022 1,816.80 338,37 1,478.43
r Regularand Overtime Earnings Taxes oe —
RegHours  RegPay  OTHours OT Pay _ FED SSDisMLVEE 112.64
FED MedicareEE 26.34
FED Withholdng 150.34
40.00 992.00 | * FED SS/Dis ER 112.64
* FED MedicareER 26.34
r OtherEarnings r Deductions
Code Hours Amounts Add to Gross
UNT 800.00 Y
AWP 1.00 24.80 Y

ADP Enterprise HR screen print as of: 04/22/2022 02:38 PM