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APPROVfli,s13 DATc 1 a AFFIDAVIT/NOTICE OF CLAIM STATE OF ARIZONA 14 JUL. 25 111111: 35 COUNTY OF MARICOPA HUI.;AU RESOURCES Traci Stutsrnan BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: (2.-D That on the day of 20 14 , he/she presented to Maricopa County, for payment a claim for services rendered or supplies furnished during the month of February , said claim being in the sum of Three Hundred Nineteen dollars and no cents Dollars ($ 319.00 ) in payment of which the Board of Supervisors caused the Warrant No. 22167854 to be issued on February 26 , 2014 , 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. 22167854 In the sum of Dated: , 20 ti Signed: ant ***A $12.00 fee for the stop payment and reissuance of the warrant replacement check.*** o before me this 12-1 7-)A-NIEL Notat y TORRE2 Public My Commission Expires March 15, 2017 manoopa County