STAMPED & REDACTED - FOR AGENDA ATTACHMENT - GARY CHATEL.PDF

Maricopa County
Human Resources

RECEIVED
Memo “nop!

. MARICOPA COUNTY
To: Juanita Garza, Clerk of the Board GLEAK BOARD OF SUPERVISORS

From: Tammy O’Keefe
Date: June 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 Tammy at ext. 67647 for any questions. Please route
approved Affidavits back to County Payroll, Suite 800.

Stale Dated Warrant Duplicate Warrant

Thank you.

91:€ Hd S- RNAP F202
2
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Replacement Lost Warrant Form 1 02/25/2015

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.
Gary Chatel (1), being first sworn, upon oath deposes and says:

Namie/Claimant

On or about 08/22/2024 (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

warrant/check be issued to him/herin the sum of $992. 18 -(3)

Signed: Aan On. (4)

Note. Please Geach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.

(5) “ite to before me this qt) day of SMAQL 20714.

— PuBuig/ Yo, gees
- Commiseton't af 454
comrnissi expires: ig
“ACA LS Se erway or 2088) (seal
Warrant/Check Number
(if known) (6) _ 52903288 _
Original Date of Issue
(itknown) (7) 7 [08/22/2024

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

Q For Services or Goods furnished

1 Treasurer’s refund/payment
O Other:

Revised April 2015 6/5/24

Maricopa Cou: 1 W. Jefferson St Sui Phoenix. AZ 85003 _ +4 (602) 5063519

Name ICompany iD] _ Pay Period Begin Pay Period End Check Date] Check Number

|Gary Chatel [Maricopa County 04/29/2024 05/12/2024 05/22/2024)
Hours Worked) Gross Pay| Pre Tax Deductions, Employee Taxes} Post Tax Deductions, Net Pay
(Current 43.50) 2,834.65) 344.13) 500.77 897.00} 992.75}
YTD 43.50 2,834.65) 344.13) 500.77 997.00} 992.75}

Eamings Employee Taxes
[Description Dates Hours Rate Amount YTO Hours YTD Amount} |Description Amount YTD}
Admin Leave With f05/06/2024 - 05/12/2024 1 63.7 63.70 1 63.70] JOASDI 175.75 175.75)
IRegular Pay 08/06/2024 - 05/12/2024 8 63.7 509.60 8 509.60} |Medicare 41.410 41.10)
[Telecommuting 05/06/2024 - 05/12/2024 35.5 63.7 2,261.35 35.5 2,261.35] |Federal Withholding 234.11 234.14
[State Tax - AZ 49.81 49.81
Earnings 2,834.65 2,834.65] | Employee Taxes 500.77 500.77
Pre Tax Deductions Post Tax Deductions
Description Amount YTD} [Description Amount YTO}
DB - ASRS. 344.13 344.13] JASRS LTD 4.25 4.25]
Support (001795838S00/N) 992.75 992.75
Pre Tax Deductions 344.13 344.13] | Post Tax Deductions 997.00 997.00
Employer Paid Benefits Taxable Wages. a
[Description Amount YTD} [Description Amount YTD
IASRS LTD 4.25 4.25] |OASDI - Taxable Wages 2,834.65 2,834.65)
IDB - ASRS 344,13 344.13] |Medicare - Taxable Wages 2,834.65 2,834.65
Federal Withholding - Taxable Wages 2,490.52 2,490.52
Employer Paid Benefits 348.38 348,38] |State Tax Taxable Wages - AZ 2,490.52 2,490.52)
Federal State] z _ Absence Plans _ = ihe 2
Marital Status Single or Married filing} Description Accrued Reduced Available
separately| Floating Personal Day 8 0 al
Allowances ct) 3.00%| Sick - County 1.72 0 1.72
|Additional Withholding 0} "| [Vacation - County 2.61 oO 2.61
Payment Information z

Bai

Tam my OKeefe (MHR)

From: Christy Harmon (MHR)

Sent: Wednesday, June 5, 2024 1:29 PM

To: Tammy OKeefe (MHR)

Subject: RE: RE: Stop Payment on 5/22/24 paycheck-Gary Chatel

Yes ma’am, for yout

Stop Check Request

Your stop payment request has been submitted. If successfui, this
transaction will nat adjust employee YTD wages in your payroll system.
Adjust your payroll system if this stop payment affeots employee YTD
wages. Please make note of this transaction for future referencas.

Transaction Number; 12444433

i Item Submitted for Stop Payment

Chatel Gary
$992.75 Issued or
05/22/2024

Gheck i: 82905288

Christy Harmon
Payroll Supervisor

mari COPA Hae esourers
COUNTY MARICOPA.GOV

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Sent: Wednesday, June 5, 2024 1:22 PM
To: Christy Harmon (MHR)
Subject: RE: Stop Payment on 5/22/24 paycheck-Gary Chatel
tmportance: High

Hello Christy,

Can you please stop payment on the 5/22/24 paycheck for Gary Chatel 811150679. He never
received the paper check in the mail. The check amount is $992.75.

Maricopa Coun!

Teompany

Maricopa County

304 W_Jeffersor St_ Suite 800 Phoanix, AZ 85003

+1 (602) 5063519

-Penod-begint «Pay Perod
04/29/2024) 05/1271

Hours. Worked

23.50 2,834.65

43.50 2,834.65

Description Dates _ Rate Amount YTO Hours YTO Amount} [Description

Admin Leave With (05/06/2024 - 06/12/2024 1 63,7 63.70 1 63.70] JOASO!

Regular Pay 08/06/2024 - 05/12/2024 8 63.7 509,60 & 609,60] [Medicare

Felecommuting —- 05/06/2024 - 05/12/2024 35.5 63,7 2.261.35 35.5 2,264.35] Federal Withholding
State Tax ~ AZ

Eamings 2,834.65 2,834.63] | Employee Taxes

Description Amount YTO] Description
DB - ASRS 344.13 344.13] ASRS LTO

Support (001795838500/N)
Pre Tax Deductions 344.13 $44.13] | Post Tax Deductions
Description Amount YTD} {Description
ASRS LTD 4.25 4.25) JOASDI - Taxable Wages
DB - ASRS 344.13 344.13] Medicare - Taxable Wages

[sc Withholding - Taxable Wages
Employer Paid Benefits 348.38 348.38] {State Tax Taxable Wages - AZ
Marital Status Single or Married filing: ‘Description

separately Ftoating Personat Day

Allowances i] 3.00%5] {Sick - County
‘Additional Withholding 9 acation - County

Bank

Account Name

‘Account Number

KCheck)

Thank you,

v
MARICOPA
COUNTY

Tammy O'Keefe

HUMAN RESOURCES

Payroll Specialist

a

MARICOPA.GOV

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