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BOA tl 9r r , 2020 APR-6 Ail II: 55 I laraLJc 1 Maricopa County Human Resources Memo Fran Wcx, Fran McCarroll, Clerk of the Board From: Linda Greinke Date: April 6, 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 Linda G. at ext. 63770 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 (seal) MICHAEL COOPER Notary Publio•StateefArizons MAINCOPA COWRY Commission # 549226 Expires July 51. 2022 My commission expires: 3j,2ozz_ OSat Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: El Duplicate or 0 Stale-Dated (definitions are on page 2) STATE OF ARIZONA Numbers on I I Homipill I II on the COUNTY OF MARICOPA III II II is page 1 III Iirrrir 4&!, 74 6 3 7161f/ (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 3 ?16 (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 $ (4C l , qc.1 .(3) Signed:A (4) 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 3 a-4-' day of Kvcctk._ 202o. NOTARY PUBLIC Warrant/Check Number (if known) (6) aos3cioS 3? Original Date of Issue (if known) (7) Reason for original issue of Warrant/Check (8): N' Payroll APR 06 2020 0 For Services or Goods furnished 0 Treasurer's refund/payment 111 Other: Revised April 2015 A.R.S. 11-632 & 11-644