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AFFIDAVIT I CLERK, BOARD OF SUPERVISORS MARICOPA COUNTY STATE OF ARIZONA COUNTY OF MARICOPA Cortez Investment Co do Hammeroff Law Grow:), being first sworn, upon oath deposes and says: That on the 12th day of December 2013, they presented to Maricopa County, for payment, a claim for services rendered or supplies furnished during the month of December 2013 said claim being in the sum of Four Hundred Twenty Eight and 07/100 dollars, ($428.07) in payment of which the Maricopa County Board of Supervisors caused the Warrant Number 340014294 to be issued on 12/16/13, 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 340014294 in the sum of $428.07. Signed: 4„1.A.,:., J2 )(:) Subscribed and sworn to before me this day of My commission expires: Finance$1AP PAY\F niiiciktiA COUNTY I Revised March 2007 ms My Comm. Ex1L Jan. 11, 2018 4/2/2014 4:03:21 PM AFFIDAVIT DATE___ '-1- STATE OF ARIZONA COUNTY OF MARICOPA Hanson Pipe fk Precast, LLC, being first sworn, upon oath deposes and says: That on the 5th day of March 2014, they presented to Maricopa County, for payment, a claim for services rendered or supplies furnished during the month of March 2014, said claim being in the sum of Ten Thousand Six Hundred and 00/100 dollars, ($10,600.00) in payment of which the Maricopa County Board of Supervisors caused the Warrant Number 340021141 to be issued on 03/05/14, 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 Warr 340021141 in the sum of $10,600.00. Signed: • SubsRted and sworn t95fefore m7jthis 4- .r"' day of NOTARY PUBLIC My commission expires: G OUVE9 • .„„ Notary Public _ A STATE OF TEXAS lrorit* a My Oornrkaptp/24/201j 11cs1dataYinanceSIAP PAY\FORMS107 Affidavit Forrn Blank.doc Revised March 2007 ms 4/3/2014 8:39:55 AM AFFIDAVIT APPR 0 CLERK, BOARD OF S UPF.-RVISOF MARICORA COUNTY STATE OF ARIZONA COUNTY OF MARICOPA Kelsie McClendon, being first sworn, upon oath deposes and says: That on the 13 day of March, they presented to Maricopa County, for payment, a claim for services rendered or supplies furnished during the month of March 2014, said claim being in the sum of Three Hundred Eighty Eight dollars, ($388.00) in payment of which the Maricopa County Board Supervisors caused the Warrant Number 00340022052 to be issued on March 2014, drawn on the County's Expense Fund. Affidavit 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 00340022052 in the sum of $388.00. A/ Signed: iie. Subscribed and sworn to before me this 'R‘ 41k" day of C-- NOTARY PUBLIC My commission expires: k Li • 'It)) g DEBBIE E FOLLETT Notary Public - Arizona Maricopa County 4 11cs1data \Financet\AP PAY\FORMS\07 Affidavit Form Blank.doc My Comm. Expires Jan 4. 2018 Revised March 2007 ms 4/8/2014 4:35:11 PM P V 4 77-- AFFIDAVIT/NOTICE OF CLAIM "W • •Ilir .1'4' , ARDDPSUPEVI ORS ARICOPhOUNTY STATE OF ARIZONA COUNTY OF MARICOPA r . r- JUDIE ANN BRYANT BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on the day of APRIL , 20 14 he/sR. ft? presented to Maricopa County, for payment a claim for services rendered or supplies fumished'anrini the month of FEBRUARY 2014 , said claim being in the sum of ONE THOUSAND TWO HUNDRED AND NINETY DOLLARS AND NO CENTS Dollars ($ 1290.00 ) in payment of which the Board of Supervisors caused the Warrant No. 22167855 to be issued on FEBRUARY 26 , 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. 22167855 In the sum of $ 1290.00 • Dated: L7tj - ,20 / Signed ***A $12.00 fee for the stop payment and reissuat •I•I 11 iwvArrant will be deducted from the replacement check.*** Subscribed and sworn to before me this. i day of , 20X LORY HAMILTON . 01Ad2ona Nazar COUNTY My Commkgan Expires August 15, 2017 My commission expires: APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO: 01/31/2013 AFFIDAVIT/NOTICE OF CLAIM STATE OF ARIZONA CLERK, BOARD OF SUPERVISORS COUNTY OF MAR1COPA MARICOPA COUNTY Belva Nasingoetewa BEING FIRST DULY SWORN C.. ""'0 OATH, DEPOSES AND SAX! That on the day of , 20 /41 , he/she presented to Maricopa County, for payment a claim for services rendered or supplies furnished during the • • C month of February , said claim being in the sum of Three hundred Two dollars and no cents Dollars ($ 302.00 ) in payment of which the Board of Supervisors caused the Warrant No. 22167524 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. 22167524 In the sum of $ 302.00 e Dated: 4p; / q ,20 /4 Signed: A. Affiant ***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the replacement check.*** Subscribed and sworn to before me this /01 day of ru , 20 /9 CONNIE SEKAYUMFI TEWA My commission expires: , Ic) -!-t NAVAJO Public. State COUNTY of Arizona ' iy Commission May 12,2015 Expires (26-40//a0/6— I TP()N APPR ()VAT PT PAW MA TT RPPT ACFMFNT CHFCTC Tn. APPROVED AFFIDAVIT/NOTICE OF CLAIM „ STATE OF ARIZONA rik BOARD OF SUPERVISORS COUNTY OF MARICOPA MARICOPA COUNTY Rachelle Flores BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on the 15 day of April 2014, he/she presented to Maricopa County, for payment a claim for services rendered or supplies furnished during the month of March , said claim being in the suk of Eight hundred eighty-eight dollars and forty-one cents 1-- — Dollars ($ 88,1.41 ) in payment of which the Board of Supervisors caused:the r -a •=r-, Warrant No. 22177751 to be issued on April 09 , 20 14 , drawn on the f>3 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. 22177751 In the sum of $ 8 .41 Dated: 20 14 Signed: ***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the replacement check.*** scO Subscribed and sworn to before me this day of ion' , , 0/54 ublic OFFICIAL SEAL My commission expires: KAREN M. DICKEY NOTARY PUBLIC - State of Arizona MARICOPA COUNTY IMI, o0 15- My Comm. Expires July 1, 2015 iDf11I1•WDECDCNI/ A T DT A QL' TA A 11 PPM A OPTIA P7II`r Cr__T-prv Tn•