STAMPED & REDACTED - FOR AGENDA ATTACHMENT - JULIE RUDNICK (1).PDF
Extracted text (via ocr_local)
3354 characters
Maricopa County Human Resources hand dativercd RECEIVE Vemo De SEP 05 2024 MARICOPA GOUNTY CLERK BOARD OF SUPERVISORS To: Juantia Garza, Clerk of the Board From: Zell Bullis Date: September 5, 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 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 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 4 08/02/2022 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/ Claim Form This application is for: Duplicate or C 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. Julie Rudnick (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 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 rere ey in the sum of $369.50 (3) Signed: \ aaa (4) Note: Pipase ect 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 30th day of Av Qu St_20aY. Parowera nh amor NOTARY PUBLIC GEER, FRANCES HANSON My commission expires: (ep Nolan Pubie State of zona Fe az 202 toa Commission # 6240 Expires February 23, 2% gel) Warrant/Check Number (if known) (6) 52963177 Original Date of Issue (if known) (7) 8/14/2024 Reason for original issue of Warrant/Check (8): [Y]Payroll L_]For Services or Goods furnished 9/6/24 L_Itreasurer’s refund/payment : - _lother: Revised April 2015 A.RS. 11-632 & 11-644 Maricopa Counly 301 W, Jefferson St. Suite 800 Phoenix, AZ 85003 sulie Rudnick Ber +1 (602) 5063519 Pay Berk heck Date] Check Number ame compan f f Wulie Rudnick Maricopa County 07/08/2024} 07/21/2024] 07/31/2024[ = Hours Warked|: 76 Gross Pay| © Pre Tax Deductions! ‘Employee Taxes}. Post Tax: Deductions| |Current 0,00} 49.50) 0.00] 9,00) TD 0,00) 49.50) 0.00] 0.00) ‘Eamings Earnings Description Dates. Hours Rate Amount YTD Hours YTD Amount! Central Board Workers 07/08/2024 - 07/21/2024 3 14.5 43.50 3 43.50) Election Incentive Pa Q7/15/2024 - 07/21/2024 3 2 6.00 a 6,00) 49.50 49.50 State Tax Taxable Wages - AZ ‘Description Amount YTO! (Federal Withholding - Taxable Wages 49.50 49.50! 49.50 49.50) Marital Status Single or Married filing separately (Allowances: id 0.00% ditional Withhalding i} te] ayment Informatio: Bank Account Name Account Number USD Amount Amount (Check) 49.50 __ USD!