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APPROVEU bATE OCT 1 2014 AIWA AFFIDAVIT/NOTICE OF CLAIM 201 110CT 28 PH IF: 32 STATE OF ARIZONA •/;- OCT 29 PI 2: 13 MAR1COPA COUNTY P,E.30LIRCES DEPT, OF ELECTIONS COUNTY OF MARICOPA Ri; IA; James Matthew Sarli BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on the 6th day of October , 20 14 , he/she presented to Marieopa County, for payment a claim for services rendered or supplies furnished during the month of August , said claim being in the sum of One Hundred Thirty Dollars ($ 130.00 ) in payment of which the Board of Supervisors caused the Warrant No. 22222789 to be issued on September 24 ,20 14 , drawn on the Payroll Clearing Account fund. Affiant further says that although he/she was informed and believes that the above mentioned warrant was regularly issued, the same has never been received, or has been lost. Under penalty of perjury, affiant hereby affirms that this claim is correct and the amount shown is due and owing. WHEREFORE, affiant requests that the Board of Supervisors issue to him/her a duplicate of said Warrant No. 22222789 In the sum of $ 130.00 Dated: ?of Gi , 20 I Li Signed: cyrk.i2-1 /71.1 / Affiant ±±±74-$4-27004ee for the-stop-pnyment-au-cl-re- f-the-w-ftprant-will-he-deduet-ed-fram-the repleeement cheek.*** Subscribed and sworn to before me this I( day of 04,:cr, 20 I 1 Notary Public My commission expires: WEINEM AMANDA A SAKI Notary Public.State of Arizona Maricope County My Commission Expires UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO: July 09, 20.15 AFFIDAVIT/NOTICE OF CLAIM 14 OCT 30 FM 1:148 STATE OF ARIZONA 20140CT 29 PM 3: 11 COUNTY OF MARICOPA HUMAN RESOURCES MARICOPA COUNTY DEPT. OF ELECTIONS Jodi Lynn Webb BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on the 13th day of October , 20 14 , he/she presented to Maricopa County, for payment a claim for services rendered or supplies furnished during the month of August , said claim being in the sum of One Hundred Fifteen Dollars ($ 115.00 ) in payment of which the Board of Supervisors caused the Warrant No. 22222235 to be issued on September 24 , 20 14 , drawn on the Payroll Clearing Account fund. Affiant further says that although he/she was informed and believes that the above mentioned warrant was regularly issued, the same has never been received, or has been lost. Under penalty of perjury, affiant hereby affirms that this claim is correct and the amount shown is due and owing. WHEREFORE, affiant requests that the Board of Supervisors issue to him/her a duplicate of said Warrant No. 22222235 In the sum of $ 115.00 Dated: / 4:14,760e16 "/ Httl. ***A S12-.40 fee for the atop payment and-reistuanee-afthe-warrant-wilHlie-dedatted-from-the replacement &acetic*** Subscribed and sworn to before me this Pilay of C/ , 20/11- )) ry Public My commission expires: I VNN .0 Li. CONRAD 7-2.-167 y PON UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO %It1111.1 \riro .1.1%.2.2016