STAMPED & REDACTED STEVEN YOUNG AFFIDAVIT.PDF

MARICOPA COUNTY

Office of Budget and Finance
301 West Jefferson

Phoenix, Arizona 85003

INTEROFFICE MEMORANDUM

Date: November 5, 2021 RECEIVED -éreiud
To: Clerk of the Board NOV 05 202)
From: Walter Chang CLE MARICO! “4 COUNTY

Office of Budget and Finance ERK BOARD OF SUPERVISORS

Subject: Affidavits - Replacement of Lost Warrants

Please find attached 1 Affidavits for lost warrants to be included on the next available

Board Agenda.

e The attached items have been researched to ensure the warrant in question
have not been cashed or previously re-issued.

e The original warrants have a void/stale date/stop payment done.

Please call me at 506-8747 if you have any questions. Please return the approved
affidavits to my attention in the Office of Budget and Finance.

Thank you.

Re: Fund: 100 /Dept: Human Resources / Company : Steven Young

Application for a Duplicate or Stale-Dated Warrant/ Check

Affidavit/Claim Form

This application is for: Duplicate or CI state-Dated (definitions are on page 2)

STATE OF ARIZONA Note: Numbers on this form correspond to
COUNTY OF MARICOPA numbers on the Instruction sheet which is
pade 2 of this form.
Steven Young (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 97-Jul-2021 (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 $1, 201.58 .(3)
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Signed: nog aetna (4)

Note: Pleas&attachia copy ofthe warrant/check if available and/or any other
evidence that a warrant/check was originally issued.

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dala sD il 2302200
Original Date of aue 07-Jul-2021
Reason for original issue of Warrant/Check (8):
Payroll
11/05/2021

1 For Services or Goods furnished

O Treasurer's refund/payment
1 Other:

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ores

Maricopa County

Human Resources

Payroll & Employee
Records Division

Phoenix, AZ 85003-2143
Phone:
Payroll Fax:

Records Fax: Date: October 27, 2021
To: Maricopa County Finance Department
From: Maricopa County Payroll
Re: Stop Payment on Warrant

Please place a stop payment on the Warrant list below. It has been
determined that the Warrant is outstanding as of this date:

Fund: 766

Warrant Number: 3012302200

Issue Date: 07/07/2021
Payable to: Steven J Young
Amount: 1,201.58

Reason for Stop Payment: employee never received.

Authorized Signature — Payroll Specialist

Stop pay manual warrant 08/02/2016

Revised

Paycheck

Name. Young,Steven Jeffrey Confirmed Check

Check# Issue Date Earnings Taxes =~ —S«eductions Net Pay
2302200 07/07/2021 1,752.84. “1551.26 : 4,201.58

- Regularand Overtime Eamings = : r Taxes :
RegHours. Reg Pay : OTHours. | OT Pay FED SSDisMLVEE
a ee FED... MedicareEE
FED Withholdng
* FED ‘SS/Dis ER
* FED MedicareER

- OtherEarnings :
_ Code Hours Amounts. Add'to Gross
LVN 81.87 175284 YS

« Deductions ~

ADP Enterprise HR screen print as of: 09/21/2021 03:25 PM

- Hnployer has wet return aidan.

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— NO expos r