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AFFIDAVIT CLERK, MARICOPA BOARD OF COUNTY SUPERVI STATE OF ARIZONA, COUNTY OF MARICOPA Marc Gondales, being first sworn, upon oath deposes and says: That on the 15th day of May, 2014, Maricopa County agreed to an Indemnity payment, in the sum of One Thousand Eighty-eight Dollars and Fifty Cents, ($1,088.50) in payment of which the Board of Supervisors caused the Warrant No.AD 00340027920 to be issued on May 15, 2014, drawn on the Expense Fund. Affiant further say that although they were informed and believe that the above mentioned warrant was iegulaily issued, the same has never been received, or has been lost., Wherefore, affiants pray that the Board of Supervisors issue to them a duplicate of said Warrant.No.AD 00340027920 in the sum of $1,088.50. Signed: Subscribed and sworn to before me this 11 day of , -2011/ . My commission expires: )3 nom 269/6 2c1Tam, noBot mosH410,.A. Notary Public - Arizona Return original signed, notarized form to: My Comm. Mack Expires opa County Mar 13, 2016 Maricopa County-Risk Management Dept. 222 N. Central Avenue, St., #1110 Phoenix, AZ 85004 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for El Duplicate or Stale-Dated (definitions are on page 2) STATE OF ARIZONA Note: Numbers on this form correspond to COUNTY OF MARICOPA numbers on the Instruction sheet which is Dace 2 of this form. Joseph John Good (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 05-Dec-2012 (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 isswiltililyc/her in the sum of $ 627.98 .(3) Signed: (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 v.ul day of s_lt.4,1%1 zo NOTARY PUBLI RANDY ADRIAN PARRA NOTARY PUBLIC - ARIZONA My commission expires: Marlowe County - A-/ 1 My CornWulon October 4,2017 Expires (seal) Warrant/Check Number 779667 (if known) (6) Original Date of Issue 05-Dec-2012 (if known) (7) Reason for original issue of Warrant/Check (8): IP-771P cLERK, BOARD OF SUPF tjVISORS MARICOPPL COLN LI For Services or Goods furnished Treasurer's refund/payment Tax Year 2012 Other: Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: R1 Duplicate or 0 Stale-Dated (definitions are on page 2) STATE OF ARIZONA Note: Numbers on this form correspond to COUNTY OF MARICOPA numbers on the Instruction sheet which is page 2 of this form. JUDITH LEW1S-THOME (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 24-Mar-2014 (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 or 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/chec be issued to him/her in the sum of $600.00 , (3 ) Signed: (4) Not . 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 82:91) day of -.7.-.1o.dwz_ 20 t NOTARY PUBLIC-z IsTrr, ROULA ASSAF My commission expires: .,\ NOTARY Maricopz PUBLIC County - ARIZONA r V2--124--)V=5" Mv Comml;v4on . Ff.g.ovis . . , r June •• 7.05''''') Warrant/Check Number 340022795 (if known) (6) Original Date of Issue 24-Mar-2014 (if known) (7) Reason for original issue of Warrant/Check (8): D Payroll 1151 For Services or Goods furnished March 2014 0 Treasurer's refund/payment 0 Other: 7 , _ — AK, BOARD OF SUPERVISORS MARICOPA COUNTY Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: I/I Duplicate or 0 Stale-Dated (definitions are on page 2) STATE OF ARIZONA Note: Numbers on this form correspond to COUNTY OF MARICOPA numbers on the Instruction sheet which is Page 2 of this form. canyon trails unit 4 south hoa (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 14 -Apr-2014 (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/chet‘k be i d to)3icerffler in the sum of $ 750.00 .(3) Signed: (4) Note: Please ättatha copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. NOTARY POBLIC ALAN K BAUM NOTARY PUBLIC - ARIZONA My commission expires: My Maricopa Commission County Expires eS, 2.0, Lo ll December 20,2017 Warrant/Check Number 00340025171 (if known) (6) Original Date of Issue 14-Apr-2014 (if known) (7) Reason for original issue of Warrant/Check (8): O Payroll O For Services or Goods furnished O Treasurer's refund/payment Other: ease-500-96-905 APPROVED CLERK, BOARD OF SUPERVISORS MARICOPA COUN-v Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: 0 Duplicate or Stale-Dated (definitions are on page 2) STATE OF ARIZONA Note: Numbers on this form correspond to COUNTY OF MARICOPA numbers on the Instruction sheet which is Dade 2 of this form. ALL PIEROGI KITCHEN (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 01 -May -2013 (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 $ 315.00 .(3) Signed: (4) Note: Please attach a/4-4y 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 I-A day of 20 N NOTARY PUBLIC ANN VAUOIHN Notary Public - Arizona My commission expires: My Marlowe Commission County Expires - 1A-2015- March 04,2015 (seal) Warrant/Check Number 330021572 (if known) (6) Original Date of Issue 01-May-2013 (if known) (7) Reason for original issue of Warrant/Check (8): El Payroll n For Services or Goods furnished E Treasurer's refund/payment Other: Refund for Retail Food permit number FD-27906 APP OVILD 1 8 2014 DATE ARD OF SUP MAFif HI LLINIVY AFFIDAVIT/NOTICE OF CLAIM STATE OF ARIZONA COUNTY OF MARICOPA Sarahita Botello BEING FIRST DULY SWORN (A) OATH, DEPOSES AND SAYS: "X) That on the 23rd day of June , 2014 , he/she presented C-11 • • to Maricopa County, for payment a claim for services rendered or supplies furnished during the month of June , said claim being in the sum of Seven hundred sixty nine dollars and ninety one cents Dollars ($769.91) ) in payment of which the Board of Supervisors caused the Warrant No. 0022195281.: to be issued on June 18 ,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. 0022195282 In the sum of $769.91 Dated: aV4,13 , 20 /K Sign7 10‘26 /Affiant ***A $12.00 fee for the stop payment and reastranfe of the warrant will be deducted from the replacement check.*** Subscribed and sworn to before me this 2 OFFICIAL SEAL EILEEN WILLIAMS-PREAS My commission expires: NOTARY PUBLIC - State at Arizona MAR1COPA COUNTY ot 4614 My Comm. Expires Nov. 9, 2014 UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO: 01/31/2013 AFFIDAVIT/NOTICE OF CLAIM 14 JUL —1 PM 3109 STATE OF ARIZONA HUNAN RESOURCES COUNTY OF MARICOPA ,e BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on the Zi-teA day of , 20 /j , hekh,-&presented to Marieopa County, for payment a claim for services rendered or supplies furnished during the month of /772-i6/ , said claim being in the stun of 7ãb he://70/7i',-7 ' 1/ Awe rAw2,t5 -- 67,71-/ e(32,h(ie,,,7tfac Dollars ($ Z Lo5 4'19' ) in payment of which the Board of Supervisors caused the Warrant No. Z.0/37798/ to be issued on , 20 /42/ , 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 hirriker)a duplicate of said Warrant No. Zap? 7 9A9/ In the sum of $ „ A fi y, Dated: „LI,/ /11L, Ar.) , 20 i Signed: Subscribed and sworn to before me this 20 161/ JEAN qiffithAbve o. -spatt ./ My commission expires: Notary Public State of AriZona Marlcopa County( My Commission Expires._ July 31, 2015 [to L, UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO: 7/23/2010 APPROVED AFFIDAVII7NOTICE OF CLAIM DAT _/VO, STATE F ARIZONA K, MAFIICOPA BOARD OF S COUNI'Y UPE FiVIS ORS COUN I r \ I•\ P.IMPA Rente \&Marris BEING FIRST DULY SWORN OATI I. )1TOSES AND SAYS: -hat on the Li day of_aat , 20 Lf , he/she presented to Writ , ) ,:t County, for payment a elaim for services rendered or supplies furnished during the 111( )11111 , said claim being in the sum of _sem-en vIondiril EJ ollars and eleveet cant;s. . Dollar: 1 Bo. t ) in payment of which the Board of Supervisors caused the Warrant 1...2 cle-ni to be issued on aistij , 20 N , drawn on the 1 ) :Ivro1' '...!Hg Account fund. further says that althouph he/she was informed and believes that the above mentioned warrani :L —ularly issued, the same has never keen received, or has been lost. Under penalty of perjury. hereby a Millis that this claim is e ,rrect and the amount shown is due and owing. IEREFORE, affiant requests that the I uoard of Supervisors issue to him/her a duplicate of said \Varrant 2.11c1 In the sum ()CS eo 1):Ited: ,20 Sipnod: PATRICIA Notary Public. D. State THOEM,KE, 101Allidtbil inch sworn to before tile this clay of J1,4_ ) MARICOPA COUNTY My Commission Expires November 14, 2016 . V Co' Ti C. Att4/0 16-- I ' Ai,\ I PI 1-:AcT7 MA11.1.'1 7 1) 1 A CI '` I I:NT rru- Tn• ip a „ FOC, ROARD OF SUPERVISORS AFFIDAVIT/NOTICE OF CLAIM MABICOPA COUNTY 14 JUL —9 PH 1: 12 STATE OF ARIZONA HUMAN RE SOURCES COUNTY OF MARICOPA afg 1UA BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on the AM.Rt day of , 20 itt , he/she presented to Maricopa County, for payment a claim for services rendered or supplies furnished during the month of //Oa-. , said claim being in the sum of g#4 itimikeed orle. cittitts 0,4Wc CardS Dollars ($14/02 ) in payment of which the Board of Supervisors caused the Warrant No. e2-6211 q 8557 to be issued on T0414 6 ,20 144) , drawn on the Payroll Clearing Account fund. Affiant further says that although he/she was informed and believes that the above mentioned warrant was regularly issued, the same has never been received, or has been lost. Under penalty of perjury, affiant hereby affirms that this claim is correct and the amount shown is due and owing. WHEREFORE, affiant requests that the Board of Supervisors issue to him/her a duplicate of said Warrant No. I 9$ 057 In the sum of $ Dated: if,( , 20 /1( Signed: V-4 fiant ***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the replacement cheek.*** Subscribed and sworn to before me this 94-day of , 20 crtkil-Ti111 111:(KEY My commission expires: liff ')1/11S S of Arizona triL111111'11 11.1INTY rG6411I11'. .1(;;;'.)C.,,.y 1, 2015 Je=,-14-, ir 0 V DATE JUL -1,8 2014 AFFIDAVIT/NOTICE OF CLAIM g JUL -9 AM 8: 53 STATE OF ARIZONA HUMAN RESOURCES. COUNTY OF MARICOPA BEING FIRST DULY SWORN , 20 1 (11 , he/she presented to Maricopa County, for payment a claim for s ces renaered or supplies furnished during the , said claim being in the sum of I 51,30 ,OR in payment of which the Board of Supervisors caused the to be issued on ,20 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' y In the sum of $ /530 ) LW Dated: ,20 / SignedS. Affiant ***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the replacement check.*** Subscribed and sworn to before me this dHRISTIE FOEHLING Notary Public - Artzona maricopa County My commission expires: 3/0y1;20/ Expires 03/24/2017 APPROVED ' I r DATE JUL 8 2014 I% •-,,;-. xi. 0. r-, 1., - MARICOPA COUNTY AFFIDAVIT/NOTICE OF CLAIM 14 JUL 1 1 PH 3: 54 STATE OF ARIZONA HUMAN RESOURCES COUNTY OF MARICOPA SAty\rIAn; e..\Oki BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on the (0'41 day of (..) , 20 1 , he/she presented to Maricopa County, for payment a claim for services rendered or supplies furnished durin g the month of ‘Ll , said claim being_ in the sum of Ot\e'llAw)c, (NA orie, hurldrecl f 4-k1 f-0- 0 . Dollars ($ S4. 3 ) in payment of whicth the Board of Supervisors caused the Warrant No[2-2. -2° 240V to be issued on -3(ALI I LP ,20 i , 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 penalt y of pedury, affiant hereby affirms that this claim is correct and the amount shown is due and owin g . WHEREFORE, affiant requests that the Board of Supervisors issue to him/her a duplicate of said Warrant No 2.2_2_4) -24 ck In the sum of $ k Dated:, 20 f Signed: ***A $12.00 fee for the stop payment and reissuance of warrant will be deducted from the replacement check*** OFFICIAL SEAL RENE' BATEElbscai ed and sworn to before me this \ray of NOTARY PUBLIC State of Arizona MARIOOPA COUNTY My Comm. Expires AprIl 4,2016 My commission expires: L\