STAMPED & REDACTED - ALAN ASHER.PDF

Maricopa County
Human Resources

To: Juantia Garza, Clerk of the Board

From: Zell Bullis EGOS

Date: December 28, 2022

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 Zell Bullis at ext. 60409 for any questions. Please
route approved Affidavits back to County Payroll, 8" Floor.

Stale Dated Warrant Duplicate Warrant

Thank you.

Replacement Lost Warrant Form 4 08/02/2022 \

Application for a Duplicate or Stale-Dated Warrant/Check

Affidavit/Claim Form

This application is for: Duplicate or _] stale-Datea (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.

Alan Asher (1), being first sworn, upon oath deposes and says:
Name/Claimant

On or about 08/17/2022 (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

mee issued to hi in the sum of $446.00 (3)
\——— (4)

Note. Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.

Signed:

5), Subscribed and sworn to pefore me this 2\*t _Z\"" day of NOVeMNeC_ 2022.

al hin { ana 4
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NOTARY PUBLIC

MET KATHERINE ROSE JARRELL
1) Notary Public - Arizona

. wo Yavapai C
y commission expires: CS Commission # 638213
: , Se” My Comm, Expires Sep 23, 2026 (seal)

Warrant/Check Number

(if known) (6) 23153913
Original Date of Issue

(if known) (7) 08/17/2022

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

Payroll
Cc For Services or Goods furnished

L_}treasurer’s refund/payment
[_Jother: 12/28/2022

Revised April 2015

MC1 -Maricopa County

- Asher,Alan

2120 - Election Day Services

Off Cycle: N
Separate Check # 0
Reprint: N

Company: MC1
Pay Group: ELE
Period End 08/07/2022

ELE-Elections Page. 91 Adjustment: N
Active. {1/03/2020 Temp/PT Line; 4
-- Asher,Alan - MC41/ELE
Paycheck View
Name Asher,Alan Confirmed Check
Check# Issue Date Earnings Taxes Deductions Net Pay
23153913 08/17/2022 446.00 446.00
~ Regular and Overtime Earnings r Taxes =
Reg Hours Reg Pay OT Hours OT Pay a.
r OtherEarnings r Deductions
Code Hours Amounts Add to Gross
EPS 23.50 23,50 Y
EPT 32.50 422.50 Y

ADP Enterprise HR screen print as of: 12/22/2022 12:55 PM