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Maricopa County Human Resources Ni emo RECEIVED metas AUG 12 2020 : MARICOPA COUN To Fran McCarroll, Clerk of the Board CLERK BOARD OF SUPERVISORS From: Linda Greinke Xe, Date: August 12, 2020 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 Linda G. at ext. 63770 for any questions. Please route approved Affidavits back to County Payroll, Suite 220. Stale Dated Warrant Duplicate Warrant an ——— 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: [7 Duplicate or CI 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. IZ mel A Aa | DC (Ce (1), being first sworn, upon oath deposes and says: Name/Claimant On or about %: 9):2070 (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 Smane the sum of $. OBA. ee) (3) Aw I (4) Note. Please aac] a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. G Subscribed and sworn to on this__ /O day of a S 2020 . NOTARY PUBLIC My commission expires: (seal) Warrant/Check Number < su (if known) (6) Z 2070 aor Original Date of Issue LO ea (if known) (7) 65-2070 _ DyG-1-2 Deu Reason for original issue of Warrant/Check (8): J giilf x Payroll O1 For Services or Goods furnished. QO Treasurer's refund/payment O Other: Revised April 2015 A.R.S. 11-632 & 11-644 - Blalock, PamelaG MC1 - Maricopa County 2270 -Workforce Development NEX-NonExempt Active 07/20/2020. Reg/FT ( Paycheck View ig Company: MC1 Pay Group: NEX Period End 07/26/2020 Page: 295 Line: 7 Off Cycle: N Separate Check #.0 Reprint: N Adjustment: N Name Blalock,Pamela G Confirmed Check Check# Issue Date Earnings Taxes Deductions Net Pay 23020842 08/05/2020 117.25 98.40 589.55 r Regularand Overtime Earnings r Taxes RegHours RegPay OTHours OT Pay FED SSDisMLVEE 49.92 FED MedicareEE 11.68 FED Withholdng 36.53) 38.00 764.94 * FED SS/Dis ER 49.92 2.00 40.26 * FED MedicareER 11.68) r OtherEarnings r Deductions Code __ Hours Amounts Add to Gross 14 After-Tax 1.45 12 Before-Tax 96.95 * 42 Nontaxable 96.95 * 14 Nontaxable 1.45 ADP Enterprise HR screen print as of: 08/10/2020 11:17 AM hogs 2ASV-— « | Uy Sood