STAMPED & REDACTED - FOR AGENDA ATTACHMENT - CAROLINE HARRISON.PDF

Maricopa County
Human Resources

Memo

To: Juantia Garza, Clerk of the Board 2
=

From: Zell Bullis 2

Date: November 13, 2024

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 itern(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 Zell Bullis at ext. 60409 for any questions. Please
route approved Affidavits back to County Payroll, 8" Floor.

Stale Dated Warrant

Duplicate Warrant

Thank you.

Replacement Lost Warrant Form

08/02/2022

Application for a Duplicate or Stale-Dated Warrant/Check

Affidavit/Claim Form

This application is for: Duplicate or (1 Stale-Dated (definitions are on page 2)

STATE OF ARIZONA | Note: Numbers on this form correspond to numbers on the '
SOUNTY OF MARICOPA | Insvuction sheet wi.ch is page 2 of this forin.
Caroline Harrison (1), being first sworn, upon oath deposes and says:
“~Name/Claimant
On or about 8/14/2024 (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 dicre 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 tnat a replacement

wartant/check be issued to him/her in the sum of $ 225-77 _ (3)
7. aff
Signed: Ve ciated osteo (4)

Note: Please attach a copy of the warrant/check if available anayor any other
evidence that a warrami/check was originally issued.

(5) Subscribed and sworn to before me this 21 __day of Sopa 20 2H,

5-4 Cc Lh flaw

NOTARY PUBLIC
gsi ‘etn c waven
My commission expires: Ce) yitatoope Gounty, Arizona
e Im. “ I
te . Se Gomiission No. 614114 (seal) i
it
Warrant/Check Number
(if known) (6). 52962596
Original Date of Issue
(if known) (7) 8/14/2024

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

(_TFor Services or Goods furnished
(Treasurer's refund/payment

[_Jother: | 11/14/24

Revised April 2015

Maricopa County 301 W. Jefferson SL Suile 800 Phoenix, AZ 85003 +4 (602) 5063519

08/04/2024 08/14/2024

(Caroline Harrison faricopa County

(Current 329.77]
YTD 0.00; AS2.00 442.96)
Description Dates Hours Rate Amount YTO Hours YTD Amount] |Description Amount YTO}
(Central Board Wark07/22/2024 - 06/04/2024 24 14.5 304.50 28 406.00} {State Tax - AZ 673 9.04)
Election Incentive P07/29/2024 - 08/04/2024 16 2 32.00 23 46.00

Earnings 336,50 452.00] | Employee Taxes 6.73 9.04
Description Amount, YTO|
[Federal Withholding - Taxabie Wages 336,50 452.00]
[State Tax Taxable Wages - AZ 336,50 462.00}

Marital Status. Single or Martiad filing separately!

Allowances: 0; 0.00%

Additional Withholding 0)

Bank Account Name Account Number USD Amount Amount

(Check) 329.77 _ USD}

W
MARICOPA
COUNTY

Human Resources
Payroll & Employee Records Division

301 W. Jefferson St., 8th Floor
Phoenix, Arizona 85003 DATE: November 13, 2024

P: 602-506-3519
F; 602-372-8722 sous
TO: Kristin Storm

Maricopa.gov

FROM: = Zell Bullis
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: _52962596
Issue Date: _ 08/14/2024
Amount: $329.77

Reason for Stop Payment: Employee didn’t receive check.

Zell Bullis

Authorized Signature — Payroll Specialist

Date Stopped Stopped by

Transaction Number Time Stopped