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frkt, 'VD 2020 APR -8 PM Maricopa County Hiliman Resources Memo To: Fran McCarroll, Clerk of the Board From: Tiffany Parkerson Date: April 8, 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 at ext. 6-2406 for any questions. Please route approved Affidavits back to County Payroll, Suite 220. Stale Dated Warrant Thank you. Replacement Lost Warrant Form 02/25/2015 warrant/check be )ssiied to IV lid Signed: er in the sum of $ 357 -39 .(3) (4) TIFFANY PARKERSON Notary Public- State of Arizona MARICOPA COUNTY My Commission Expires May 18. 2021 My commission expires: , On3 I K, BOARD OF SUPERVISORS MAHICOPA COUNTY 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 Note: Numbers on this form correspond to numbers on the COUNTY OF MARICOPA Instruction sheet which is page 2 of this form. Wendell, Mark Charles Name/Claimant On or about 3/17/2020 (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 (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 ,5? day of IN, 20 at). Warrant/Check Number (if known) (6) 2301307 Original Date of Issue (if known) (7) 3/17/2020 Reason for original issue of Warrant/Check (8): RI Payroll O For Services or Goods furnished O Treasurer's refund/payment O Other: Revised April 2015 A.R.S. 11-632 & 11-644 (seal) Warrant Number - 3012301307 Status I Stopped Account # I Paid Date I Issued Date 03/17/2020 Payee Amount Wendell Mark Charles $357.39 Interest $0.00 Claim # Sub Fund I Dept # PO # LowOrig Voucher Registered Date DashBoard Page 1 of 1 https://treasurer.maricopa.gov/AgencyWeb/Dashboard 4/8/2020