Extracted text (via pymupdf)
3464 characters
202 FF, 21 : er.v.R Maricopa County Human Resources Memo To: Fran McCarroll, Clerk of the Board From: Tiffany Parkerson Date: April 21, 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 P. at ext. 62406 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 Signed: (4) 23010306 4/15/2020 LENE POPE Notary Public- State of Arizona MARICOPA COUNTY My Commission Expires AprIl 4, 2021 (seal) APPROVED Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: Duplicate or 0 Stale-Dated (definitions are on page 2) STATE OF ARIZONA COUNTY OF MARICOPA Note: Numbers on this form correspond to numbers on the I nstruction sheet which is page 2 of this form. Jose Galvez Name/Claimant On or about 4/15/2020 (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 bein g found or presented for pa yment, 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 re q uests that a replacement warrant/check be issued to him/her in the sum of $ 1,114.10 .(3) ( 1), being first sworn, upon oath deposes and says: 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 gl day of igprA, 20 "Z_P My commission expires: NrI Warrant/Check Number (if known) (6) Original Date of Issue (if known) (7) Reason for original issue of Warrant/Check (8): IR Payroll El For Services or Goods furnished LI Treasurer's refund/payment 111 Other: Revised April 2015 A,R.S. 11-632 & 11-644 MC1 - Maricopa County 8850- Environmental Health Services NEX- Non Exempt Active 03/23/2020 Reg/FT Company: MCI Pay Group: NEX Period End 04/05/2020 Page 1482 Line: 4 Off Cycle: N Separate Check # 0 Reprint: N Adjustment: N MEE - Galvez,Jose R - MCVNEX r Paycheck View MCY-Earnings Taxes Deductions Garnishments Special Accumulators Distributions Name Galvez,Jose R Confirmed Check Checkli Issue Date Earnings Taxes Deductions Net Pay 23010306 04/15/2020 1,600.00 224.92 260.98 1,114.10 Regular and Overtime Earnings I Reg Hours Reg Pay OT Hours OT Pay 40.00 800.00 40.00 800.00 'Taxes — FED FED FED * FED * FED SSDisMLvEE 95.26 MedicareEE 22.28 Withholdng 96.62 SS/Dis ER 95.26 MedicareER 22.28 r Other Earnings --- Code Hours Deductions 80 14 184 48 50 Amounts Add to Gross After-Tax After-Tax Before-Tax Before-Tax Before-Tax 3.64 2.72 20.83 33.86 0.66 ADP Enterprise HR screen print as of: 0412112020 10:29 AM