STATE DATED WARRANTS-FINANCE 1.PDF

NOTICE OF CLAIM
STATE OF ARIZONA
COUNTY OF MARICOPA
CHAD A. ROCHE as representative for the AZ ASSOC SUPERIOR COURT CLERKS,
being first sworn, upon oath deposes and says:
That on the 12TH day of March, 2013, they presented to Maricopa County, for
payment, a claim for services rendered or supplies furnished during the year of 2013,
said claim being in the sum of Three hundred and 00/100 dollars, ($300.00) in payment
of which the Maricopa County Board Supervisors caused the Warrant Number
330018116 to be issued on 03112/13, drawn on the County's Expense Fund.
Claimant 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, claimant requests that the Board of Supervisors issue to him/her a
duplicate of said Warrant Number 330018116 in the sum of $3oo.00.
Signed:
Subscribed an' w• n to before me this I 1 45 day of Aptit
40
IardarrAii.- '162F.P4
TAMMY Nobly K. Public SCI-ISLI..
My Coinicision Wiles
January 1 2016
Pinal Counly
llcsldata\Finance$1AP PAY IFORMS107 Affidavit Form Blank.doc
Revised March 2007 ms
9/2/2014 11:11:04 AM