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RECEIVED MAY 0 6 2014 A FFHAWNAG EMENT DOARD orsupE-M7Edns MARiCOPA COUNTY STATE OF ARIZONA, COUNTY OF MARICOPA Silvio Pavlovic , being first sworn, upon oath deposes and says: That on the 26th day of March, 2014, Maricopa County agreed to an Indemnity payment, in the sum of One Thousand Two Hundred Fifty Eight Dollars and Four Cents, ($ 1,258.04) in payment of which the Board of Supervisors caused the Warrant No.AD 00340023340 to be issued on March 26, 2014, drawn on the Expense Fund. Affiant further say that although they were informed:and believe that the above mentioned warrant was regularly isReckInp„same has , never been received, or , has been lost.' •. WA , 1 Wherefore, affiants pray that the Board of Supervisors issue to them a duplicate of said Warrant No.AD 00340023340 in the sum of $1,258.04 Signed: Subscribed and sworn to before me this day of My commission expires: Return original signed, notarized form to: • .MariCopa'County-Risk Management Dept. , 222 N. Central Avenue, St,;#11:10 -, ', 'ALLISON OFFICIAL MOWERY SEAL Phoenix, AZ 85004 NOTARY MARICOPA PUBLIC COUNTY ARIZONA My Commission Expires:4/27/2017 AFFIDAVIT APPROVED DAT- STATE OF ARIZONA COUNTY OF MARICOPA EVIDENCE SOLUTIONS, INC, being first sworn, upon oath deposes and says: That on the 18th day of February 2014, they presented to Maricopa County, for payment, a claim for services rendered or supplies furnished during the months of January - November 2013, said claim being in the sum of Six Thousand Two Hundred Eighty and 00/100 dollars, ($6,280.00) in payment of which the Maricopa County Board of Supervisors caused the Warrant Number 340023583 to be issued on 3/31/14, drawn on the County's Expense 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. WHEREFORE, affiant requests that the Board of Supervisors issue to him/her a duplicate of said Warrant Number 340023583 in the sum of $6,280.00. Signed: Subscribed and sworn to before me this C day of ft:72_2n_ c)-01 NOTARY PUBLIC My commission expires: 0 /(a / 6 1-1A01 KOBEISSI Notary Public - Arizona Pima County IlcsldatalFinancd\AP PAY IFORMS1137 Affidavit Farm Blank.doc My Comm. Expires Aug 1, 2016 Revised March 2007 ms 11"UPTP,"11P•MTV'WPW"W"I""UP". 4/23/2014 2:05:43 PM AFFIDAVIT/NOTICE OF CLAIM STATE OF ARIZONA COUNTY OF MARICOPA BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: r713 (f) That on the 15-k\t". day of M , 20 , he/she joresented to Maricopa County, for payment a claim for services rendered or supplies furnished during the month of re 84. (/ , said claim being in the sum of Dollars ($ qq.00 ) in payment of which the Board of Supervisors caused the Warrant No. 2211,053V+ to be issued on 2- 2 to , 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. 2-2 16 S 8 9- In the sum of $ Dated: 1/4 r r , 20 1 41 Signed: Affiant ***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the replacement cheek.*** Subscribed and sworn to before rneAhis rfY day My commission expires: /6- AFFIDAVIT/NOTICE OF CLAIM STATE OF ARIZONA COUNTY OF MARICOPA 4 vylkz(-1,.?s. csc..-tnZ BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on the 2-5 day of Howe! , 20 19 , he/she presented to Maricopa County, for payment a claim for services rendered or supplies furnished during are - month of , said claim being in the sum of _ co >rrtf• I •91A-y tko.e. 4 4 100 •••TI —yr Dollars ($ (0S-e., • $•\ ) in payment of which the Board of Supervisors caused the t : (o) Warrant No. 0012 tabs sn to be issued on toMd. 2 , 20 1'1 , drawrF8n 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. C.)0 2.2.% 1's— '1 In the sum of $ tn. 1k Dated: isitI‘..s. 2to , 20 ILA Signed: Affiant ***A $12.00 fee for the stop payment and reissuance of the warrait -scill be deducted from the replacement check.*** Subscribed and sworn to befew IN this *25?) day of1A3 Wary Public - State of Aria= My commission expires: My MARICOPA Commission COUNTY Expires 3Lnc, June 4, 20113 \211p UPON APPROVAL PLEASE MAIL REPLACEMENT CHFCK TO STATE OF ARIZONA COUNTY OF MARICOPA dier 'm8AFfeAlc--06p*A c8407 3NaTy-' Maria Murphy being duly sworn, upon oath deposes and says; That on the 22nd day of May 2014 he/she presented to the Treasurers of Maricopa County, for payment, a claim for services rendered or supplies furnished during the month of May , said claim being in the sum of three hundred eighty four and 621100 dollars ($ 384.62 ) in payment of which the Superintendent of Schools caused his/her Warrant Number 140088346 to be issued on May 15 2014 , drawn on the 779 Fund of Treasurers of Maricopa County, Arizona. Claimant further says that although he/she was informed and believed that the above- mentioned warrant was regularly issued, the same has never been received or has been lost. Under penalty of perjury, claimant hereby affirms that this claim is correct and the amount shown is due and owing. Wherefore, claimant requests that the Board of Supervisors order and the Superintendent 140088346 of Schools issue him/her a duplicate of said Warrant Number in the sum of 384.62 Claimant Signature Subscribed and sworn before me this VA fa Notary Pu c My commission expires 9 701 7 Following approval please return this affidavit to Maricopa County Education Service Agency.