WENDELL_REDACTED.PDF

Maricopa County — Formal (2020-04-22)

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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