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Stale Dated Warrant Duplicate Warrant Maricopa County Human Resources Memo To: Fran McCarroll, Clerk of the Board From: Tiffany Parkerson Date: May 27, 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 Tiffany at ext. 6-2406 for any questions. Please route approved Affidavits back to County Payroll, Suite 220. Thank you. RECEIVED Rm4 amord DS. MAY 2 9 2020 MARICOPA COUNTY CLERK BOARD OF SUPERVISORS 02/25/2015 Replacement Lost Warrant Forrn warrant/check be issued t(hinfrh' Signed: Note: Please attach a copy evidence that a warrant/chec 4-3\of $1,593.79 .(3) (4) of (the warrant/check if available and/or any other wafiginally issued. (seal) TIFFANY PARKERSON Notary Public State of Arizona MARICOPA COUNTY My Commission Expires May 18, 2021 My commission expires: Appilkakm Tole a Duplicate or Stale-Dated Warrart/Check Affidavit/Claim Form This application is for: • Duplicate or El Stale-Dated (definitions are on page 2) STATE OF ARIZONA COUNTY OF MARICOPA Note: Numbers on this form correspond to numbers on the Instruction sheet which is page 2 of this form. Eddie Reyes Name/Claimant (1), being first sworn, upon oath deposes and says: On or about 5/27/2020 (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 an q(ivjrig, and the applicant requests that a replacement (5) Subscribed and sworn to before me this day of 20 Warrant/Check Number (if known) (6) Original Date of Issue (if known) (7) 23014172 15/27/2020 Reason for original issue of Warrant/Check (8): Payroll El For Services or Goods furnished 0 Treasurer's refund/payment 111 Other: Revised April 2015 A.R.S. 11-632 & 11-644