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Maricopa County Human Resources Memo To: Fran McCarroll, Clerk of the Board From: Tiffany Parkerson Date: June 3, 2020 Re: Replacement of Lost Payroll Warrants RECEIVED-uhwi ,Dut Quro as. JUN 0 4 208 MARICOPA COUNTY CLERK BOARD OF SUPERVISORS 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. Stale Dated Warrant Duplicate Warrant Thank you. Replacement Lost Warrant Form 02/25/2015 the sum of $ 1770 .59 .(3) (4) My corn n expires: Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: Duplicate or ri Stale-Dated (definitions are or pale a) 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. Rhone, David M Name/Claimant / /12020 On or about 5 (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 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 2.1.1" day of Mal 2020 . (---. (1), being first sworn, upon oath deposes and says: Sarah Heet Notary Public Pinal County, Arizona My Comm. Expires 04-17-2023 Commission No. 563630 (seal) Warrant/Check Number (if known) (6) 2301361 Reason for original issue of Warrant/Check (8): Payroll 0 For Services or Goods furnished E Treasurer's refund/payment LI Other: Original Date of Issue (if known) (7) 5/1/2020 Revised April 2015 A.R.S. 11-632 & 11-644 Warrant Number -3012301361 Status Account # Paid Date Issued Date Registered Date Payee Amount Interest Claim # Sub Fund Dept # PO # LowOrig Voucher Issued Rhone David M $1770.59 $0.00 DashBoard Page 1 of 1 https://treasurer.maricopa.gov/AgencyWeb/Dashboard 6/3/2020