STAMPED & REDACTED TAZARAI AL'DAWNNA MONROE.PDF

Maricopa County
Human Resources

Memo

To: Juanita Garza, Clerk of the Board APR 18 2022

From: Daniel Villalba
Date: April 18, 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 Daniel at ext. 62406 for any questions. Please route
approved Affidavits back to County Payroll, Suite 400.

Stale Dated Warrant Duplicate Warrant

Thank you. Deo

Replacement Lost Warrant Form 4 02/25/2015

Application for a Duplicate or Stale-Dated Warrant/Check

Affidavit/Claim Form _ Coun Sg

This application is for: H bupticate 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.
“Togacic Ate Dovwnna Moneoe (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about April a Wad (date)(2) a warrant/check was issued to the

above named pelson/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

(3)

(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 Fe) day of Prout 2022.

NOTARY PUBLIC
SHER, EILEEN WILLIAMS-PREAS
My commission expires: - Notary Public State of Aizona
WO - 2022 Commission # ss4a49 (seal)
Expires November 9, 2022

Warrant/Check Number
yaeck Mu 23125 180

Original Date of Issue

(if known) (7) US) 0a7

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

O For Services or Goods furnished 04/18/2022
QO Treasurer's refund/payment -
O Other:

Revised April 2015 He QWOAAST] rte ar Wal tara

| - Monroe, Tazarai A
MC1- Maricopa County

8001 - Presiding Judge
NEX-NonExempt

Active 10/11/2021 Reg/FT

Company: MC1
Pay Group: NEX
Period End 04/03/2022
Page 1181
Line: 6

Off Cycle: N

Separate Check # 0

Reprint: N
Adjustment: N

- Monroe, Tazarai A - MC1/NEX

( Paycheck View { MCY-Earnings [ Taxes { Deductions { Gamishments | Special Accumulators Distributions

Transit#: 122187238

Name Monroe, Tazarai A Confirmed Check and Advice
Check# Issue Date Earnings Taxes Deductions Net Pay
23125180 04/13/2022 1,493.88 198.46 321.00 974.42
Check/Advice# Type Account# Amount =
3651842 Checking 55013486912345250 101.05
Transit#: 113024164
3651842 Checking 14007856160400 115.05

Transit#:

ADP Enterprise HR screen print as of: 04/18/2022 10:05 AM