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AFFIDAVIT
APPIECONLD
oATE of '9/ ' N i f
aCiARb
MARICOP,', COL Nr''
STATE OF ARIZONA
COUNTY OF MARICOPA
DHI TITLE, being first sworn, upon oath deposes and says:
That on the 13TH day of September, 2013, they presented to Maricopa County, for
payment, a claim for services rendered or supplies furnished during the month of
September 2013, said claim being in the sum of Seven hundred fifty and 00/100 dollars,
($750.00) in payment of which the Maricopa County Board Supervisors caused the
Warrant Number 340006473 to be issued on 09/13/13, 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 340006473 in the sum of $750.00.
Signed:
Subscribed and sworn to before me this day of c2'e
Y PUB
My commission expires: WA51,2-Y.0 : , A LULY OFFICIAL M. RODRIGUEZ SEAL !
Notary Public - State of Arizona !
! -..:41---1-2,;t7 MARICOPA COUNTY i
•I•••I be I•••••I•• I=1.•• My CAmm. I•••••I•••.mg.I.E.....e Expires April Iy..,II•.....11. 25, 2016 i
Vy-slc:EfiY'inanc P/V." FORIA.; 07 .Inc:av::. U.Cc..rtg
Revised March 2007 ms
2/26/2014 8:12:28 AM
AFFIDAVIT/NOTICE OF CLAIM
STATE OF ARIZONA CLERK, IVARICCPA BOARD OF COUNTY SUPERVISORS
COUNTY OF MARICOPA
KAREN PATRICIA DAVILA BEING FIRST DULY SWORN
OATH, DEPOSES AND SAYS:
That on the 5TH day of NOVEMBER , 20 13 , he/she presented
to Maricopa County, for payment a claim for services rendered or supplies furnished during the
month of NOVEMBER , said claim being in the sum of
ONE HUNDRED FIFTEEN and 00/100 DOLLARS
—
Dollars ($ 115.00 ) in payment of which the Board of Supervisors caused the --c:
Warrant No. No. 22142776 to be issued on November 20 , 20_13 dra‘M one
Payroll Clearing Account fund. (—)
Affiant further says that although he/she was informed and believes that the above mattVp — neg f.A.)
warrant was regularly issued, the same has never been received, or has been lost. Under penaltraf tit
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. 22142776 In the sum of $
Dated: in arth tith ,20 I 4 Signed:
Affiant
4114414ft/idefatiliat golptdoMept4nOtAitgOltep1afIkeAkkillflpiiirb#41041461%144111,9
/1140,44114rt(0441atv
Subscribed and sworn to before me this _41tviday of jMilidri_, • 20
)
NotarY Public
My commission expires:
0 I Le
AL, PLEASE MAIL REPLACEMENT CHECK TO:
APPROVED
AFFIDAVIT/NOTICE OF CLAIM
CLERK BOARD OF SUPERVigrtiRS
STATE OF ARIZONA MARICCf*A COUNTY
COUNTY OF MARICOPA
BRIAN DRYSDALE BEING FIRST DULY SWORN
OATH, DEPOSES AND SAYS:
That on the 28 day of FEBRUARY 20 14 he/she
presented to Maricopa County, for payment a claim for services rendered or supplies furnished during the
month of AUGUST 2013 , said claim being in the sum of
TWO HUNDRED ANt) EIGHTY-EIGHT DOLLARS AND NO CENTS .
Dollars ($ 288.00 ) in payment of which the Board of Supervisors caused the
Warrant No. 22120623 to be issued on AUGUST 28 , 20 13 , 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. 22120623 In the sum of $ 288.00
Dated: .20 / 1/— Signed:
Affiant
***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the
replacement check***
Subscribed and sworn to before me this
My commissi in expires;
3 /2.0 zo/ 1./
UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO:
01/31/2013
AFFIDAVIT/NOTICE OF CLAIR
STATE OF ARIZONA
COUNTY OF MARICOPA CLERK, YARICOPA BOARD OF COUNTY SUPERViSORS
TARA E. ACUNA BEING FIRST DULY SWORN
OATH, DEPOSES AND SAYS:
That on the 26 day of February , 20 14 , he/she
presented to Maricopa County, for payment a claim for services rendered or supplies furnished during the
month of AUGUST 2013 , said claim being in the sum of
NINE HUNDRED AND THIRTY-FOUR DOLLARS AND NO CENTS
Dollars ($_934.00 ) in payment of which the Board of Supervisors caused the
Warrant No. 22118388 to be issued on AUGUST 28 20 13 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. 22118388 In the sum of $ 934.00
Dated: g/Rt7 ,20 /9 Signed:
Affiant
***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted
replacement check.***
Subscribed and sworn to before me this c,4..(1 day of 20/
ti/ny'
My _,-- commission expires:
J uLy 015,
UPON APPROVAL. PLEASE MAIL REPLACEMENT CHECK TO:
01/31/2013
APPRO,VED
AFFIDAVIT/NOTICE OF CLAIM DATE,
411.77 4
Oirjcf '‘c-eD
STATE OF ARIZONA blA.:-7tCC°A Ca..A7v
COUNTY OF MARICOPA
EDWARD SCHEFFNER BEING FIRST DULY SWORN
OATH, DEPOSES AND SAYS:
That on the /1 day of gkeil , 20 /,/ , he/she presented to
Maricopa County, for payment a claim for services rendered or supplies furnished during the
month of AUGUST 2013 , said claim being in the sum of
FIVE HUNDRED AND NINETY-ONE DOLLARS AND NO CENTS
Dollars ($ 591.00 ) in payment of which the Board of Supervisors caused the
Warrant No. 22120321 to be issued on AUGUST 28 , 20 13 ,awn ,
the Payroll Clearing Account fund.
Affia.nt further says that although he/she was informed and believes that the above mi rtit - ionv4
warrant was regularly issued, the same has never been received, or has been lost. Under pen' of= 1:
perjury, affiant hereby affirms that this claim is correct and the amount shown is due and owing'. 9
(Ls)
WHEREFORE, affiant requests that the Board of Supervisors issue to him/her a duplicate Ofsaid
Warrant No. 22120321 In the sum of $ 591.00
Dated: , 20 ..,/y Signed:
***A $12.00 fee for the stop payment and reissuance of/flip/warrant will be deducted from the
replacement check.***
Subscribed and sworn to before me this day of /('L V), 20 1 -
.•I••I••I......earmosmssm.••I••I••me.... •
OFFICIAL SEAL
My commission expires: K. FULGHUM j
Notary Public - State otArIzona
MARICOPA COUNTY
My Comm. Excites/tug. 2,2017
UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO:
01/31/2013
03/17/2014 09:12 6023720277 MC PAYROLL PAGE 01/01
APPROVD IE I
DATE
AFFIDAVIT/NOTICE OF CLAIM
r ,BOROGT7SU MARZTDAWUNTY
STATE OF ARIZONA
COUNTY OF IVIARICOPA
tillt(A-A-fiel, /*Men-70 BEING FIRST DULY SWORN
,–...
OATH, DEPOSES AND SAYS: r- —
That on the 11 day of fn OP-C±4- , 20 / / , he/she present;d
C,
to Marieopa County, for payment a claim for services rendered or supplies furnished during the
C.'
month of firelzcid- , said claim being in the sum of (-
a--mC y /0- p, .
Dollars ($ 6;7 3, 6 Z. ) in payment of which the Board of Supervisors caused the
Warrant No. 2 2 I-11) 4.L, to be issued on .3 1 Z - , 20 , drawn on the
Payroll Clearing Account fund.
Afflant 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, I/ ) j Igo In the sum of 5Z
Datxi71.,t'.M 5) 1 / ,20 ) 4t Signed:
Yln Affiant
***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the
replacement check***
Subscribed and sworn to before me this 1 7 day of titatCA , 20 ILI
ciALLA--NoI–
Notary Public EILEEN WILLIAMS-PREAS hAMLOVAL
My commission expires: NOTARY PUBLIC State of Arizona
MARICOPA COUNTY
U. My Comm, Expire; Nov, 9, 2014
UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO:
W31/2014
AFFIDAVIT/NOTICE OF CLAIM
STATE OF ARIZONA
COUNTY OF MARICOPA —0
BEING FIRST DULY SWORN CJ1
OATH, DEPOSES AND SAYS:
That on the 1_1.04*/ day of Q, roo,,,f , 20 i , he/she presented
to Maricopa County, for payment a claim for services rendered or supplies furnished during the
month of Ce..,b( 04- ,said claim being in the sum of
Of F I VC Ok0Val
Dollars ($ 5. 00 ) in payment of which the Board of Supervisors caused the
Warrant No. StROLPOS2i to be issued on e.,‘Cif Lfief (1-(11 , 20 kik , 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. 1. '2.1 tç.Q t oyS In the sum of $
Dated: , 20 14 Sign
'ant
***A $12.00 fee for the stop payment and reissuance of the warrint will be deducted from the
replacement check.*** Fee, woo/0 si-&
OLIVIA ihrbicamilsmie M. PADILLA m tc -iefore me this Ya day of in`rf'-1( , 20/'(
Pins! County
/ My Commission Expires rY)
August 11,2014
Notary Public
My commission expires:
I .13/111/41 A IMO/AU Al III 1 A CC 11 AA TI D COI A r'CILAC11.11" ln_111, 17
APPROVED
DATE 76 1
AFFIDAVIT/NOTICE OF CLAIM
K, BOARD OF SLIrERVISCRS
MARICOPA COUNTY
STATE OF ARIZONA
COUNTY OF MARICOPA
Socorro C Herrera BEING FIRST DULY switoic.)
(r) c)
OATH, DEPOSES AND SAYS:
That on the day of March , 2014 he/she presented
to Maricopa County, for payment a claim for services rendered or supplies furnished during the
month of February , said claim being in the sum of
One Hundred Thirty dollar's
Dollars ($130.00 ) in payment of which the Board of Supervisors caused the
Warrant No. 22166827 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. 22165827 in the sum of $130.00
Dated: 3 // ,20 Signed: lAZ-2L6
Affiant
***A $12.00 fee for the step payment and reissuance of the warrant will be deducted from the
replacement check. ***
Subscribed and sworn to before me this 113_ day of Marth ,20 ki4
?Att)-1141
OFFICIAL SEAL
My commission expires: NOTARY EILEEN PUBLIC WILLIAMS-PREAS - State of Arizona
My Comm. MARICOPA Expires COUNTY Nov. 9, 2014
AFFIDAVIT/NOTICE OF CLAIM CLERK. BOARD OF SUPERVISORS
MARICOPA COUNTY
STATE OF ARIZONA
315.
COUNTY OF MARICOPA
Gina Hoffarber BEING FIRST DULY SWORN
rr:
OATH, DEPOSES AND SAYS:
That on the eighteenth day of March , 2014, he/she presented
to Maricopa County, for payment a claim for services rendered or supplies furnished during tie
month of March , said claim being in the sum of
Six hundred ninety six dollars and forty eight cents
Dollars ($ 696.48 ) in payment of which the Board of Supervisors caused the
Warrant No. 22171266 to be issued on March eighteenth. 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. 22171266 In the sum of $ 696.48
Dated: March eighteenth, 2014 Signed:
Affia
***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 C) i day of MarCit , 20 Lf
My commission expires: 41(51 L L. MICHAEL OFFICIAL D. ROUNTREE SEAL
Notary Public - State of Arizona
MARICOPA COUNTY
My Comm. Expires June 15, 2014
UPON APPROVAL. PLEASE MAIL REPLACEMENT CHECK TO: