STAMPED & REDACTED - FOR AGENDA ATTACHMENT - MICHAEL MCGINN.PDF
Extracted text (via ocr_local)
3231 characters
Maricopa County Human Resources Memo To: Juantia Garza, Clerk of the Board From: Zell Bullis Date: January 4, 2024 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. Qe Replacement Lost Warrant Form 1 08/02/2022 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: Duplicate or L] 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. Michael McGinn (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 11/22/2023 (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, 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 $1090.69 (3) Signed: WK Wee (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 _Z at _45 * day of Decemyper 20.23. Voth Pin Bass) NOTARY PUBLEC (ay Mier Lenn Ser My commission expires: ey apes re, 01131 |2024 — (seal) Warrant/Check Number (if known) (6) me (16208 Original Date of Issue (if known) (7) 11/22/2023 Reason for original issue of Warrant/Check (8): Payroll LIFor Services or Goods furnished__ L_ treasurer's refund/payment L_Jother: 1/04/2024 Revised April 2015 Maricapa County 301 W. Jefferson St. Suite 800 Phoenix, AZ 85003 __ +4 (602) 5063519 Michael Meginn Wame SS _ [Company — eee Se mployes: eriod Pay Period End| Check Date| Check Number] Michael Mcginn Maricopa County I l 40/30/2023] 44/12/2023 11/22/2023] : ee es _Hours Worked| Pre Tax Deductions, Employee Taxes} Post Tax Deductions| (Current 0.00 0.00 0.00 0.00 TD 0.00 4,187.64] 0.00 0.00 0.00 1,187.64 Description Hours Rate Amount YTD Hours YTD Amount Central Board Workers 13 OT 10/30/2023 - 11/12/2023 8 13.85 166.20 8 166.20] (Central Board Workers 13.85 10/30/2023 - 11/12/2023 66.75 13.85 924.49 73.75 1,021.44 Earnings 1,030.69 1,187.64 Amount YTD! 1,080.69 4,187.64 1,080.69 1,187.64 tate Description Federal Withholding - Taxable Wages State Tax Taxable Wages - AZ Marital Status Allowances 0} 0.00% [Additional Withholding te) 0) = Account Name Account Number. USD Amount Amount (Check) 4,090.69 __ USD]