STAMPED & REDACTED - FOR AGENDA ATTACHMENT - RACHEL PHILLIPS.PDF

Maricopa County
Human Resources

Memo

To: Juantia Garza, Clerk of the Board

From: Zell Bullis

Date: June 17, 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

08/02/2022

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Application for a Duplicate or Stale-Dated Warrant/ Check

Affidavit/ Claim Form

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

STATE OF ARIZONA Note; Numbers on this form correspond to numbers on the
COUNTY OF MARICOPA Instruction sheat which is page 2 of this form.
Rachel Pips (1), being first sworn, upon oath deposes and says:
On or about AN 012024 (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 $ 387-87 (3)

Signed: akLAH, : (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) Subscribed and sworn to before me this __{ / th day of Une 20 att

NOTARY PUBLIC

SO}
ota Publ Biale af Azone
My commission expires: Commission #024002

Feb 23, 2020 Qa” Expires February 23, 2028 tect!)

Warrant/Check Number
(if known) (6) 52876800 ;

Original Date of Issue
{If known) (7) 4/10/2024

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

(]For Services or Goods furnished
[_}treasurer’s refund/payment
LJother:

a

_ 6/19/24
Revised April 2015 Ahh ig Ht : = /19f

v
MARICOPA
COUNTY

Human Resources
Payroll & Employee Records Division
301 W. Jefferson St., 8th Floor

Phoenix, Arizona 85003 DATE:
P: 602-506-3519
F: 602-372-8722
TO:
Maricopa.gov
FROM:
RE:

June 14, 2024

Christy Harmon/Lisa Platek

Zell Bullis

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: 52875800

Issue Date: _ 04/10/2024
Payable to: _ Rachel Phillips _
Amount: $387.87

Reason for Stop Payment:

Never Received

Attach a print screen of the paycheck view.

Zell Bullis

Authorized Signature — Payroll Specialist

Date Stopped

Transaction Number

Stopped by

Time Stopped

St cute £10 Phsenik AZ ISR +t

1402) SCORE

‘Pay Period Begin!

‘Gheck Uae) Check: Humber}

jRachel Philips Maricopa County

0318/2024]

oss 12024| oasiorz02s]

Hetis Worked! 2. Pretax Deduetions| Tax: Deductions}
Kourrent Cr) 337.87 0.00) 0.00
iD. . 5.00} 6.094

lOezcaipiion

Dates Hous Rate ___Amounl _YTO Hows _VTD Amoun!
[Centrat Board Workers 03/15/2024 - 03142024 26.75 45 307.67 29.75, A317
Eamings 37.87 $31.37

Team Wage

Desciiption

Amount

Federal Wilnholding « Taxable Visage 357.87 43457
[Stale Tay Taxable Wages - AZ 387.87, 433.37,

- 5 : Federal]
juaital Status ‘Single of Married fling separately
Allowances f)
Lagdidionai * ig o)
a yn
{Bank Account fame Account Fiumber USO Amou! Amount
Uchoeky 937,87 USD}

Tammy OKeefe (MHR)

From: Zell Bullis (MHR)

Sent: Monday, June 17, 2024 12:40 PM

To: Tammy OKeefe (MHR)

Subject: Replacement check for 10th floor

Attachments: Cover letter for 10th floor.docx; Paystub 4_10_ 2024.docx; Affidavit Cover letter - 10th
Floor.doc

Importance: High

Hi Tammy,

When you have moment, could you please print and send this up to the 10" floor. The payroll check
has been stopped by Jessica. Thank you.

Thank: Yt,

Zell Bubhis

MA ave OPA HUMANREsouRCES
COUNTY PAYROLL DEPT

301 W Jefferson 8" Floor Phoenix, Arizona 85003
Payroll Specialist

O: 602-506-0409 F: 602-372-8722
MARICOPA.GOV
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