REDACTED - FOR AGENDA ATTACHMENT - ALMA ZAZUETA DE ARIAS.PDF

Maricopa Gounty
Flumnan Resources
2024 HAR re

Viemo

3
To: Juanita Garza, Clerk of the Board 5 z S
From: Tammy O’Keefe 5 Bae,
Date: March 14, 2024 2 ae
Re: Replacement of Lost Payroll Warrants Fs %
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 Tammy at ext. 67647 for any questions. Please route
approved Affidavits back to County Payroll, Suite 800.

Stale Dated warant >) Duplicate Warrant
Oe soon

Thank you.

Replacement Lost Warrant Form

02/25/2015

| wsarmese

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form

This application is for: CO Duplicate or 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.
Aima Zazueta De Arias (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about 02/21/2023 (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, gr 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

$3525.86 3)

warrant/check be issyed to him/her in the sum of
Signed: Z hu (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 ~[& day of Mowth 2004 .

GER SABRA SUEVER d
(3/ en Notary Public - Arizona
ie IF) Maricopa County

S Ze) Commission # 649296

£912. My Comm, Expires Jun 8, 2027

NOTARY PUBLIC

My commission expires:
‘ (seal)

Warrant/Check Number 13949393528

(if known) (6)

Original Date of Issue 02/21/2023

(if known) (7)

Reason for original issue of Warrant/Check (8):
m Payroll

C1 For Services or Goods furnished

( Treasurer's refund/payment
@ Other: Expired/Stale Dated.

Revised April 2015 A.R.S. 11-632 & 11-644

WARRANT NO. 3012309528

Maricopa.County

301 W. Jefferson St.
Suite 800 sae
Phoenix, AZ 85003 2 2.

Wligwences

Additional Withholding

Earnings Statement

Porind Beginning: O2iGH2023
Parlod Ending; ; o2isi20z3
Payment Dale: 02/21/2023

y Wartant Nuraber; , 9012503528. |°

Alma Zazuicta De Arias

Admin Leave Witly FO2CG/Z023 ~ oma ! i : 5 f
Lump Sum Vacator02/06/2023 + 02/17/2023 AB = * 3,210.89 2 79)210.89) Me ee i ‘
_‘{Muttitingual Differer 02/06/2023 - 02/17/2023 1 0.00 52,00} [Federal Withhakding Ci eede | PTE 768,84 1,088.25)

Reguiar Pay a) Seon, 1,220.96) [State Tak AZ 020 86.65 199.06}
= Wellness 60 02108/2023 - 02/17/2023 0 30,00: 420,00} |”
= i sania CTI9-Z9 12,774 ,89]

[Description = Amount YTD} [Description % = 5 Amount YTO
[Deferred Conipensaton - 50+ Pog ns 2 220,00] ASRS ETD : Cra ets @Bd. 2 18.22
PB - ASRS L282 226,97". 4,138,11] |Add} AD/D Securian EE ~ wa BBB 18.80

e SG.TE 98,58] [Addl Life. Secudan. 19.27". 96.95)

+ 64.140). 256,86) IChild tite - Secivian. ; 0.925 4.60
4.03 5.06] Patalts Not Displayed - 47.80 88.00

1746.27

Poet Tax Deductions

YTD)

Description.”

13:22
4:70
340

1,136,141
2,266.14

3,420.87

i - Taxable Wages
dicare = Taxable Wages s
‘adoral Withhdiding - Taxdbte Wages
tale Tak: Taxable Wages - AZ

12,414.73] os.

12,414.73

41,088.62) *: