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Et-AK. BOARD OF '5 UP EPVSC AFFIDAVIT/NOTICE OF CLAIM MA7. , :77.7 ,'A 14 MAR 21 PM 315C STATE OF ARIZONA FIVIAN RESOMIES COUNTY OF MARICOPA & e_s BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on on the ria/ day of , 20 ILl , he/she presented to Maricopa County, for payment a claim for services rendered or supplies furnished during the month of Plata, , said claim being in the sum of Agit 64ttlid mid? ori 61066 and daz ceed5 Dollars ($ IRA 52- ) in payment of which the Board of Supervisors caused the Warrant No. c: 69.17/177 to be issued on Ala- 12- , 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 shov. -n is due and owing. WHEREFORE, affiant requests that the Board of Supervisors issue to him/her a duplicate of said Warrant No. c2A1 7/1 77 In the sum of $ Dated: Mitiat. 61/ , 20 Signed: k 4c Affi ant ***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 •:at day of Icg,i4;74\ , 20 My commission expires: OFFICIAL SEAL 1 1111_1490v4_ AL/6 KAREN M. DICKEY „14PON ;APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO: NOTAIIYPUBIJC MARICORI - State COUNTY of Arizona My Comm. Expires July 1, 2015 Name: Telephone Number: ....14- 111•IMNa .mr--110311• Address: Address: 4/3/2012 AFFIDAVIT STATE OF ARIZONA COUNTY OF MARICOPA INSIGHT PUBLIC SECTOR, being first sworn, upon oath deposes and says: That on the 14 day of February, 2014, 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 Sixteen thousand six hundred forty and 00/100 dollars, ($16,640.00) in payment of which the Maricopa County Board Supervisors caused the Warrant Number 340019509 to be issued on 02/14/14, drawn on the County's Expense Fund. Affiant further says that although he/she was nformed 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 340019509 in the sum of $16,640.00. Signed: gibed and sworn tobefore me this DIA day of inardl . 00 14— My commission expires: L.1__ Nary SHERRI Pak- Slab L aMOixes MST ....] MAMMA COUNTY My Camileakin Egalres Jun! 28, 2017 11cS1datalFinance$NAP PAYIFORMS107 Affidavit Form Blank.doc Revised March 2007 ms 3/18/2014 3:20:36 PM AFFIDAVIT Wr 07.:1 D_ATAr_i ,i-e.4.,14/1:4:41I14= OlTgleTARID OF SUPERVISORS MARICOPA COUNTY STATE OF ARIZONA COUNTY OF MARICOPA WELLS FARGO BANK, being first sworn, upon oath deposes and says: That on the 24th day of February 2014, they presented to Maricopa County, for payment, a claim for services rendered or supplies furnished during the month of February 2014, said claim being in the sum of Sixty Seven thousand and 00/100 dollars, ($67,000) in payment of which the Maricopa County Board of Supervisors caused the Warrant Number 340020719 to be issued on 2/26/14, 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 340020719 in the sum cif $67,000.00. Signed: V Subscribed and sworn to before me this c1-7t1\ day of sQlrilLt11.th VIAA AMA) AfriVA NOTARY PUBLIC My commission expires: 3 — ab n Pfe Nam; Ni.1 11csliiataWinance$ \AP PAY1FORMS107 Affidavit Form Blank.doc, coroY..Bureelft zoar2m7 Revised March 2007 ms 3/26/2014 10:06:31 AM