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2020 JAN 29 AM Maricopa County Human Resources Memo To: Fran McCarroll, Clerk of the Board From: Monica Reyes Date: January 29, 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 Monica at x 6-8051 for any questions. Please route approved Affidavits back to County Payroll, Suite 220. Stale Dated Warrant (Over 1 Year) Thank you. Signed: (4) GRACIE GUERRERO Whey Public - Ebile dArizona MARICOPA COUNTY Commission I 506008 Expires May 19, 2023 ) DATE 4111Pre" . . WIN#4:74.;:417:74.amirml-01, MARICOPA 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. EAU- ?FasAZA 1‘100 0 2— (1), being first sworn, upon oath deposes and says: Name/Claimant On or about I 1i:4_1W (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 $ 35 .(3) 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 0./e7 day of NOT RY PUBLIr My commission expires: May 2d23 Warrant/Check Number (if known) (6) Original Date of Issue (if known) (7) A PP Reason for original issue of Warrant/Check (8): El Payroll El For Services or Goods furnished LI Treasurer's refund/payment 111 Other: C:\Users\williamse\AppData \Local \Microsoft\Windows\Temporary Internet Files\Content.Outlook\FITTDL74G \Warrants Checks notice of claim.doc Revised April 2015 A.R.S. 11-632 & 11-644 - Pedraza Munoz. Eric MC1 - Maricop3 County 5042 - District II NEX- Non Exempt Active 12/30/2019 Reg/FT Company MC1 Pay Group' NEX Period End 01/12/2020 Page 600 Line' 3 Off Cycle: N Separate Check # 0 Reprint N Adjustment' N - Pedraza Munoz,Eric - MC1/NEX ( Paycheck View MCY-Fatnings Taxes DeiluctibilS' Garnishments Special Accumulators Distributions Name PedrazaMunoz,Eric Confirmed Check Checkh Issue Date Earnings Taxes Deductions Net Pay 22696429 01/22/2020 2,831.15 493.14 54.66 2,283.35 r Regular and Overtime Earnings — 1 Reg Hours Reg Pay OT Hours OT Pay 32.00 793.60 40.00 992.00 - Taxes FED FED FED * FED * FED , SSDisMLvEE MedicareEE Withholdng SS/Dis ER MedicareER 172.38 40.32 205.37 172.38 40.32 – OtherEarnings r i r Deductions— Code Hours Amounts Add to Gross 92 After-Tax 8.00 198.40 Y 98A After-Tax 5.00 2.50 Y 48 Before-Tax 1.75 43.40 Y 50 Before-Tax 2.50 1.25 Y 69 Before-Tax ADP Enterprise HR screen print as of: 01/2912020 07:57 AM HPA SH1 AWP SH1 2.39 1.42 44.93 1.45 4.47