STAMPED & REDACTED WYATT MCENTIRE-METTE.PDF

Maricopa County
Human Resources

Memo

To: Juanita Garza, Clerk of the Board
From: Monica Reyes
Date: April 26, 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 Monica at ext. 68051 for any questions. Please route
approved Affidavits back to County Payroll, Suite 400.

Stale Dated Warrant Duplicate Warrant

Thank you.

Replacement Lost Warrant Form 4 02/25/2015

Application for a Duplicate or Stale-Dated Warrant/Check

Affidavit/Claim Form

This application is for: 4 Duplicate or CJ 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.
1

eaeste Me lent coe Mette (1), being first sworn, upon oath deposes and says:
jame/Craimant

On or about OY -1$- 2082 (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

wr epee een of ¢_| : 403. Tlo (3)
Signedé , Lif (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 SN _day of Aprl 2022.

Doo wrt I

NOTARY PUBLIC

LEEANNE ELLIS-LIPICZKY
Notary Public - Arizona
MARICOPA COUNTY
SO Commission # 603414

pis Expl

My commission expires:
4futoZ75

(seal)

Warrant/Check Number
(ifknown) (6) Kegfrege — tx22 Al ZSIe4
Original Date of Issue
(if known) (7) 4fre/22.
Reason for original issue of Warrant/Check (8):
Payroll
C1 For Services or Goods furnished___
C1 Treasurer's refund/payment 04/27/2022
C1 Other: ~

Revised April 2015

( Paycheck View

Name McEntire-Mette,Wyatt A Confirmed Check
Check# Issue Date Earnings Taxes Deductions Net Pay
23125169 04/13/2022 2,080.00 185.66 490.58 1,403.76
. Regularand Overtime Earnings a nr ~ Taxes ie
RegHours  RegPay  OTHours OT Pay __ FED SSDisMLVEE 115.33
FED MedicareEE 26.97
42.50 4105.00 _* FED SS/Dis ER 115.33
35.75 929.50 _* FED MedicareER 26.97
AZ Withholdng 43.36
- OtherEamings - ———— ne r Deductions -
Code Hours Amounts Add to Gross 82 After-Tax 12.40
AWP 1.75 45.50 Y 14 After-Tax 3.95
RNP 4.25 N 43P Before-Tax 183.64
50 Before-Tax 1.95
63 Before-Tax 34.46

ADP Enterprise HR screen print as of: 04/25/2022 11:49 AM