STAMPED & REDACTED ALEXANDER BRUNACINI.PDF
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BOARD COPA Maricopa County eee Human Resources 4 V Memo To: Juanita Garza, Clerk of the Board From: Lisa Platek Date: April 14, 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 Lisa P at ext. 63619 for any questions. Please route approved Affidavits back to County Payroll, Suite 800. —0gB 20 Stale Dated Warrant a Duplicate Warrant ? Thank you. Replacement Lost Warrant Form 1 02/25/2015 (i (y Affidavit/Claim Form This application is for: fa 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. Alexander Brunacini i orn, upon oath deposes and savs: NamaICEaant (1), being first sworn, upon oath deposes and says: On or about 02/02/2022 (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 $698.13 (3) Signed: t Cn (4) Note: Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. My commission.expires: he and sworn to before me this_\274 day of AfQiu 2022. ro M Lorne NOTARY PUBLIC Mideig ANTE ZO, (seal) Warrant/Check Number Check Nu 23109513 Original Date of Issue ginal Date of Is 02/02/2022 Reason for original issue of Warrant/Check (8): f Payroll O For Services or Goods furnished___ O Treasurer's refund/payment _ 0Other: ’ 04/15/2022 Revised April 2015 ( Paycheck View Name Brunacini,Alexander J : Confirmed Check# Issue Date Earnings Taxes Deductions 23109513 02/02/2022 900.00 90.18 111.69 - Regular and Overtime Earnings ; Taxes RegHours — Reg Pay OT Hours OT Pay FED SSDisMLVEE FED MedicareEE 22.50 450.00 FED SsiDis ER 22.50 450.00 FED MedicareER AZ Withholdng ~ OtherEarnings - Deductions Code Hours Amounts __ Add to Gross 14 After-Tax 12 Before-Tax 12 Nontaxable 14 Nontaxable ADP Enterprise HR screen print as of: 04/12/2022 03:45 PM ae) RICO ke o i sees i ae Couns Payroll & Employee Records Division 301 West Jefferson Street Suite 220 Phoenix, AZ 85003-2143 Phone: 602-506-3519 Payroll Fax: 602-372-0277 Records Fax: 602-506-5509 Wwww.maricopa.gov Maricopa County Human Resources DATE: 4/14/2022 TO: Eileen Williams/ Lisa Platek FROM: Lisa Platek RE: Stop Payment on Warrant Please place a stop payment on the Warrant listed below. It has been determined that the Warrant is outstanding as of this date: Warrant Number: 23109513 Issue Date: 2/2/2022 Payable to: Alexander Brunacini Amount: 698.13 Reason for Stop Payment: never received/ Lost check Attach a print screen of the paycheck view. Authorized Signature — Payroll Specialist Date Stopped U ‘| Y.22 stooped by Lt BA rate _ Transaction Number Ol 0850) Time Stopped (2. en