STAMPED & REDACTED ZION JOHNSON.PDF

ARD OF SUPERNISOR™ Maricopa County
. Human Resources

Wendt Nor: tery dt

Memo

To: Juanita Garza, Clerk of the Board

From: Monica Reyes
Date: December 8, 2021

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 x 6-8051__ for any questions. Please
route approved Affidavits back to County Payroll, Suite 220.

Stale Dated Warrant (Over 1 Year) Duplicate Warrant

Thank you.

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form

This application is for: al 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.

Zion Johnson (1), being first sworn, upon oath deposes and says:
Name/Claimant

On or about November 24, 2021 (gate)(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 iss Devon in the sum of $1 :294.15 .(3)
Signed: UD) lof MW AN (4)

7

Note. leasd att ch 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 Lod. day of Decombe rc 20Z/.

NOTARY PUBLIC

4 CHELSEA BLOOM
ee Gi za Notary Public Arizona
My commission expires: eo) Maricopa County

Ol | L PIASF. My Comm. Expires Jan 11, 2022 (seal)
Warrant/Check Number ALD (/
(if known) (6) ( 124) at (7 \
Original Date of Issue Lp LI
(if. known) (7) | | Id { 0, t
Reason for original issue of Warrant/Check (8): 12/10/2021

O) Payroll : -

OO For Services or Goods furnished
Oo bree (| ia ‘\
nt other: hy if WO2RS Neuer (ecu

Revised April 2015 ARS, 11-632 & 11-644

Payroll & Employee

Records Division

Phoenix, AZ 85003-2143
Phone:

Payroll Kax:

Records Fax:

Maricopa County

Human Resoutces

DATE: December 8, 2021

TO: Eileen Williams
FROM: Monica Reyes
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: 23094871
Issue Date: _11/24/2021_
Payable to: Zion Johnson
Amount: $1294.15

Reason for Stop Payment: Check lost in the mail/.

Attach a print screen of the paycheck view.

NvKegs |

Authorized Slanatire= Payroll Specialist

I2.«&. 24

2? LOb ne Stopped 244 ‘1 (7 -_

Date Stopped

Transaction Number

| Distributions

Name Johnson,Zion R Confirmed Check

Check# Issue Date : Earnings : Taxes i Deductions — Net Pay
23094871 41/24/2021 1,892.00 312.93 284.92 1,294.15

Check/Advice# : Type Account# _ : Amount

Transit#:

ADP Enterprise HR screen print as of: 12/08/2021 02:47 PM

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 iimited to 50 checks per request. i

_ DIRECT DEPOSIT SEARCH

Johnson Zion R i  # 23094871
$1,294.15 issued on 1724/2021 ae Unpaid/Uncashed

fr #0745

; (<] BACK

Stop Check Request

Your stop payment request has been submitted. If successful, this transaction will not adjust
employee YTD wages in your payroll system. Adjust your payroll system if this stop payment
affects employee YTD wages. Please make note of this transaction for future references.

Transaction Number: 09633404

1 Item Submitted for Stop Payment

Johnson Zion R
$1,294.45 Issued on 11/24/2021
Check #: 23094871