STAMPED & REDACTED TIFFANY LAM MENDOZA.PDF

Maricopa County
Human Resources

Memo 400

To: Juanita Garza, Clerk of the Board

From: Lisa Platek
Date: February 28, 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 220.

Stale Dated 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 D1 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.
Tiffany Lam Mendoza (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about February 16, 2022 (aste)(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 ¢1 439.12 .3)
Signed: Y= —— (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) awl sworn to before me this Q Y day of Paloma 20 Ja.
aL {Hig

NOTARY FUBLICY)

My cammission expires: ‘ Maricopa County

} phy Lavad Wwe say Commission #584842 (seal)
Warrant/Check Number
(if known) (6) 00231 1261 3

EX JENNIFER FARRUGIA
Ki; + Notary Public - Arizona
CF

eruancr [02/16/2022

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

O For Services or Goods furnished
O Treasurer's refund/payment 03/01/2022
O Other: .

Revised April 2015

Tiffany Lan Mendoza
(620) 177-2393

Lisa Platek (MHR)

SENSE
From: Rosario Ramirez
Sent: Thursday, February 24, 2022 9:26 AM
To: Lisa Platek (MHR)
Subject: Live Paycheck - PPE 2.06.2022 - Tiffany Lam Mendoza
Hi Lisa,

Employee, Tiffany Lam Mendoza, has reached out to me because she has not received her check from 2/16.
She has confirmed her address is correct in ADP.

Thank you,
Rosario Ramirez

Payroll Liaison
Maricopa County Attorney’s Office

Phoenix, AZ 85003

£32 SmartCornpliance’ Updated 02/10/2022
HOME PROCESSES:

Management & Reversals

Look up the details of a single payment or range of payments by using the form below.
NOTE: The maximum check range is limited to 50 checks per request.

| creccseanes | DIRECT DEPOSIT SEARCH

BRANCH COMPANY CODE

Pee (t

STATUS: ALL Y

a Lam Mendoza Tiffany # 23112613 it

$1,439:12 issued on 02/6/2022 Unpaid/Uncashed

ee

ce

@32 SmartCompliance’ Ce ete 8 ) Updated 02/10/2022
HOME — PROCESSES
Management & Reversals

Look up the details of a single payment or range of payments by using the form below.
NOTE: The maximum check range Is limited to 50 checks per request.

BRANCH COMPANY CODE : CHECK NUMBER/ 23112613
[J Range of check Numbers

I

STATUS: ALL ¥ Search

Lam Mendoza Tiffany & #2312613 im
$1,43912 Issued on 0246/2022 creck Stopped/Void as of 02/28/2022