REDACTED - FOR AGENDA ATTACHMENT - PAUL WEICH.PDF

2024 JAN-2 PH 4:11

Memo

To: Juantia Garza, Clerk of the Board

Maricopa County
Human Resources

From: Zell Bullis
Date: December 28, 2023

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 Warran

xo
Thank you. om

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 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.
Paul Weich (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about 11/23/2022 (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

warrant/check ri to him/her in the sum of $497.20 (3)

Signed: Vz 4 (4)

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

v

(5) Subscribed and sworn to before me this Qo day of DeCe@mber 20nS ,
LS ee
M\leurslra Leeson <
NOTARY PUBLIC

My commission expires:
Pon\ Ib, Zone

Warrant/Check Number

(if known) (6) 52486565
Original Date of Issue

(if known) (7) 11/23/2022

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

Payroll

C For Services or Goods furnished

L_}treasurer's refund/payment
_lother:

Revised April 2015 4 A.R.S, 11-632 & 11-644

Maricopa County 301 W. Jefferson Si

800 Phoenix, AZ 85003 _ +1 (602) 5063519

Name ae {Company _ “ ID] Pay Period Bagin| _ Pay Period End| Check Date] “Check Number
Paul Weich laricopa County 10/31/2022 41/13/2022! 11/23/2022)
d Gross Pay| Pre Tax Deductions| | Post Tax Deductions|
[Current 0.00) 511.00) 0.00} 0.00}
YTD 0,00 511,00) 0.00} 0.00)
2 22 Bamings : Employee Taxes eed
Description Dates Hours, Rate Amount YTD Hours YTD Amount! |Description Amount YTD)
|Central Board Work1 1/02/2022 - 11/13/2022 32.5 15 487.50 32.5 487.50] [State Tax - AZ 13.80 13.80)
[Hazard Pay 14/07/2022 - 11/13/2022 23.5 1 23.50 23.5 23.50}
Eamings 511.00 5114.00] | Employee Taxes 13.80 13.80
Taxable Wages :
Description Amount YTO!
Federal Withholding - Taxable Wages 511.00 511.00
511,00 511.00

[State Tax Taxable Wages - AZ

Marital Status

Single or Married filing separately|

(Allowances

i) 0.00%

0

[Additional Withholding

Payment Informati

Bank

Account Name.

Account Number USD Amount Amount

(Check)

497.20 __USD|

v
MARICOPA
COUNTY

Human Resources
Payroll & Employee Records Division

301 W. Jefferson St., 8th Floor
Phoenix, Arizona 85003 DATE: December 28, 2023

P: 602-506-3519
Poa 372-8722 TO: Christy Harmon/ Lisa Platek

Maricopa.gov

FROM: Zell Bullis
RE: Stop Payment on Warrant

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

Warrant Number: 52486565
Issue Date: 11/23/2024
Payable to: Paul Weich
Amount: $497.20.
Reason for Stop Payment: never cashed

Attach a print screen of the paycheck view.

Authorized Signature — Payroll Specialist

Date Stopped Stopped by

Transaction Number Time Stopped