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MAY 2 6 2020 Memo RECEIVED -HP-c9 vtAzd D5 Maricopa County Human Resources To: Fran McCarroll, Clerk of the Board MARICOPA COUNTY CLERK BOARD OF SUPERVISORS From: Debbie Upton Date: May 26, 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 Debbie U. at ext. 66329 for any questions. Please route approved Affidavits back to County Payroll, Suite 220. Stale Dated Warrant Thank you. Replacement Lost Warrant Form Dept 8012 Superior Court 02/25/2015 warrant/check be issued to him/her in the sum of $442.76 kj\ .(3) (4) Signed: /ru day of 92- bscribed and sworn to before me this / -( 4 7 20 Appiication for a Duplicate or Staie-D td Warrant/Check Affidavit/Ciaina Ftrm 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. Danielle Valerio Name/Claimant (1), being first sworn, upon oath deposes and says: On or about 3/22/2020 (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 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. Warrant/Check Number (if known) (6) Original Date of Issue (if known) (7) 23008643 3/22/2020 nZ1 Reason for original issue of Warrant/Check (8): Payroll CI For Services or Goods furnished DI Treasurer's refund/payment 111 Other: Revised April 2015 IACQUELINC SERGEANT COMMISSION M29426 NOTARY PUBLIC STri C. LAHO A.R.S. 11-632 & 11-644 - Valerio,Danielle E Company: MCI Off Cycle: N MC1 - Maricopa County Pay Group: INT Separate Check # 0 8012 - Law Library Self Service Cntr Period End 03/22/2020 Reprint: N INT - Interns Page: 5 Adjustment: N Active 01/08/2020 Temp/FT Line: , 11111111111 - Valerio,Danielle E - MC1/INT Paycheck View MCY-Earnings r Taxes I Deductions Garnishments F Special Accumulators Distributions Name Valerio,Danielle E Confirmed Check Check ti Issue Date Earnings Taxes Deductions Net Pay 23008643 04/01/2020 525.00 82.24 442.76 r- Regular and Overtime Earnings 1 Reg Hours Reg Pay OT Hours OT Pa 7 Taxes FED SSDisMLvEE 32.55 FED MedicareEE 7.61 FED Withholdng 37.88 FED SS/Dis ER 32.55 FED MedicareER 7.61 1-- OtherEarnings * Code Hours Amounts Add to Gross 7 Deductions 4H STI 525.00 Y ADP Enterprise HR screen print as of: 05/26/2020 12:43 PM