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Maricopa County Human Resources Memo To: Fran McCarroll, Clerk of the Board From: Zellnor Bullis Date: April 30, 2020 Re: Replacement of Lost Payroll Warrants 112 C:0 N) c.n ..M110 b1 '3> 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 Zellnor B. at ext. 60409 for any questions. Please route approved Affidavits back to County Payroll, Suite 220. Stale Dated Warrant Duplicate Warrant 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: Duplicate or LI Stale-Dated (definitions are on page 2) STATE OF ARIZONA COUNTY OF MARICOPA Lloyd Caronanda Carey Name/Claimant Note: Numbers on this form correspond to numbers on the Instruction sheet which is page 2 of this form. (1), being first sworn, upon oath deposes and says: On or about April 1, 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 warrant/check,be issued to him/her in the sum of $ 250.00 .(3) (4) Signed; Note: Pleyse attach a copki of the warrant/check if available and/or any other evidence that a warrant/cheek was originally issued, (5) Subscribed and sworn to before me this Zf day of ji-til, 202 . NOTARY PUBLIC My commission expires: 8 - Z5- - 3 Warrant/Check Number (if known) (6) Original Date of Issue (if known) (7) HEATHER KROOT Notary Public - Arizona Maricopa County Commission # 589266 My Commission Expires August 25, 2025 00129749 4/1/2020 (seal) Reason for original issue of Warrant/Check (8): Payroll LI For Services or Goods furnished ElTreasurer's refund/payment Daher: Revised April 2015 A.R.S. 11-632 & 11-644 - Carey Lloyd Caronanda MCI - Maricopa County 2120- Election Day Services ELE - Elections Active 11/07/2006 Temp/PT Company: MCI Pay Group: ELE Period End 03/22/2020 Page 394 Line: 7 Off Cycle: N Separate Check # 0 Reprint: N Adjustment: N - Carey,Lloyd Caronanda - MC1/ELE Paycheck View MCY-Earnings Taxes Deductions Garnishments Special Accumulators Distributions Name Carey,Lloyd Caronanda Confirmed Check Checkil Issue Date Earnings Taxes Deductions Net Pay 23007497 04/01/2020 250.00 250.00 Regularand Overtime Earnings Taxes Reg Hours Reg Pay OT Hours OT Pay OtherEarnings r Deductions Code Hours Amounts Add to Gross EPS 20.00 250.00 ADP Enterprise HR screen print as of: 04/29/2020 09:57 AM