STAMPED & REDACTED SHARI GARNER.PDF

Maricopa County
Human Resources

Memo

t
To: Juanita Garza, Clerk of the Board v *5

From: Monica Reyes
Date: March 9, 2022 TO

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 1 02/25/2015

Application for a Duplicate or Stale-Dated Warrant/Check

Affidavit/Claim Form

This application is for: 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.

Sheri E Garner and/or Shirley A Garner__(1), being first sworn, upon oath deposes and says:
Name/Claimant

On or about _ 2/7/2022 (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 $10,952.88 (3)

Signed: 4 (4)
Note: Pidase attach a 0, of the warrant/check if available and/or any other
eck

evidence that a warrant/a was originally issued.
in
Subscribed and sworn to before me this 2ND day of _MARCH 20_ 22.
NOTARY-PUBLIC
DIANE BEAUMONT
ieci, ; . tary Public - i:
My commission expires: "WARICOPACOUNTY
ission # 5’
10/20%23 Expires October 20, 2023 (seal)

Warrant/Check Number
(if known) (6) 2302598
Original Date of Issue
Oe rien 2/7/2022

Reason for original issue of Warrant/Check (8):
pero
0 For Services or Goods furnished 03/10/2022

O Treasurer's refund/payment
O Other:

Revised April 2015 AK. £1032 & LI-O4t

Paycheck View

Name Garner,Shari E Confirmed Check
Check# Issue Date Earnings Taxes Deductions Net Pay
2302598 02/07/2022 11,284.37 331.49 10,952.88

 Regularand Overtime Earnings ; Taxes

Reg Hours Reg Pay OT Hours OT Pay
24,25 936.05

r OtherEarnings = Deductions
Code _ Hours Amounts Add to Gross ! 301 After-Tax 7.87
ELP 15.75 607.95 Y 81 After-Tax 9.70
SH1 5.50 2.75 Y 91A After-Tax 4.05
ELP 24.00 926.40 Y 92 After-Tax 27.05
HOL 16.00 617.60 Y 48 Before-Tax 34.51

ADP Enterprise HR screen print as of: 03/02/2022 01:58 PM