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AFFIDAVIT
STATE OF ARIZONA
COUNTY OF MARICOPA
PRACTICING LAW INSTITUTE, being first sworn, upon oath deposes and says:
That on the 16th day of December, 2013, they presented to Maricopa County, for
payment, a claim for services rendered or supplies furnished during the month of
November 2013 said claim being in the sum of Seven hundred sixty four and 25/100
dollars, ($764.25) in payment of which the Maricopa County Board Supervisors caused
the Warrant Number 340014464 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 340014464 in the sum of $764.25.
Signed: (1 10"
Subscribed and sworn toforeirriMis 2 /4 day of fre
YESSENIA ki TAPIA
NOTARY PCJILIL± NOTARY PUBLIC-STATE OF NEW YORK
No. 01TA62351363
My commission expires: )0. VI up2 2u/S- Qualified in Bronx County
My Commission Expires January 31, 2015
llcs1datalFinance$1AP PAYWORMS107 Affidavit Form Blank.doc
Revised March 2007 ms
2/20/2014 2:06:59 PM
AFFIDAVIT/NOTICE OF CLAIM 1 DDAATT EA
CLERK, MARE' OF SUPL=RV!SORS
STATE OF ARIZONA MARICOPA CCUKV
COUNTY OF MARICOPA
cp
BEING FIRST FIRST DULY SWORN
OATH, DEPOSES AND SAYS: m CD
That on the day of 144.40 , 20 /41 he;she presented f,,)
trt
to Maricopa County, for payment a claim for services rendered or supplies furnished during the
month of 12171 , said claim being in the sum of
it://1 A2tA ,e;60-eenAz,j_
Dollars ($ ( 70 - ) in payment of which the Board of Supervisors caused the
Warrant No. 0007c2/44.2722o be issued on c2X;2 ' , 20 /171 , 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. 00a7G2/&4 In the sum of $
Dated: //cile7240' , 20 /41 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 (31.4'day ofi&Czk, 20 1q-
Notary Public 'Mrer— At
My commission expires: BILLIE BERRY
NeacujPublie A • $ic* of Moo*
rtbetwA991 / A0/ 6" Co..11 My Comm. RICOPA Expires COUNT', Feb. 19, 2015
UPON APPROVAL, PLEASE CHECK TO:
01!31/2013
14/3/3 2:58 PM
AFFIDAVIT/NOTICE OF CLAIM
CLErK, EOARD OF SUPERVISORS
STATE OF ARIZONA mAR!OOPA COUNTY
COUNTY OF MARICOPA -a
7.;
_e /.5),/g /44 BEING FIRST DULY SWORN
r-
OATH, DEPOSES AND SAYS: -0
77
That on the day of /t/101 r , 20 / el, he/she pre tedCe
to Maricopa County, for payment a claim for services rendered or supplies furnished during the 411 CO
month of 1"--t" rtn 02( i l ,2O/ , said claim being in the sum of
hafttik(24 tion 53i60
Dollars ($ 7 q.? , 5 2 ) in payment of which the Board of Supervisors caused the
Warrant No. ad I 4,10 7,2 3 to be issued on Fe- b 616 , 20 or f , 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 penalt y of
peijury, affiant hereby affirms that this claim is correct and the amount shown is due and owin g.
WHEREFORE, affiant requests that the Board of Supervisors issue to him/her a duplicate of said
Warrant No. In the sum of $
Dated: /./a/c _f ,20 / Y Signed:
Affi an t
***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the
replacement check.***
Subscribed and sworn to before ?day of /44,20
Notary Public OFFICAI.SEAL
My commission expires: BIWE BERRY
NsSwyIbhc COPA - Stoke COUNTY of Moons
btffiV 1 IS My Coma,. Expires Feb. 19.2015
T TPON AP ()VAT PT P A CP MATT R.Fifil=diriefr
01/31/2013
P1
APPY1“91/S0
DAT;
AFFIDAVIT/NOTICE OF CLAIM
CLERK, bOARD OF SUPERVISOES
IVARICOPA COUNTY
STATE OF ARIZONA
COUNTY OF MARTCOPA
MELISSA N. SANTA CRUZ BEING FIRST DULY SWORN
OATH, DEPOSES AND SAYS:
That on the 20 day of February. , 20 14 , he/she
presented to Maricopa County, for payment a claim for services rendered or supplies furnished during the
month of AUGUST 2011 , said claim being in the sum of
NINE HUN ED AND EIGRThZIGHT DOLLARS AND NO CENTS _
Dollars ($ 988.00 ) in payment of which the Board of Supervisors caused the
Warrant No. 22121518 , 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 owin g.
WHEREFORE, affiant requests that the Board of Supervisors issue to him/her a duplicate of said
Warrant No. 22121518 In the sum of $ 988.00
Dated: Rio.yit_49 "?Z.:1 ,20 !t signed: "Li, 2/
Affiant
***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the
replacement check.***
Subscribed and sworn to before me this 0)0 -k day of Ve Uko-(1 , 20_
Nritcry Public
DENA WARREN
PCT. - ARIZONA 7_L
,Ay Cornrrii&siollExpires
August 14, 2015
-L-21101E---'-reii-WW41110,WPW ,
UPON APPROVAL PLEASE MAIL REPLACEMENT CHECK TO:
01/31/2013
02/ 25/ 3a4 . RISKMANAGEMENT PAGE 02/02
1-74` ri
„ ,3 . 11 91_11 's°
DAT AFFIDAVIT ,RECEIVED
CLERK, AAPROOFA BOARD OF SUPEHVISORg Cf)LiSrv MAR 0 3 2014
STATE OF ARIZONA RISK MANAGEMENT
COUNTY OF MARICOPA
e 44, H 44-.5 L , on behalf of CEP America, being first sworn,
upon oath deposes and says:
That on the 26th day of July, 2013, they presented to Maricopa County, for
payment, a claim for services rendered or supplies furnished during the month of
May, said claim being in the sum of Three Hundred and Seventy-four Dollars
and Four Cents ($ 374.04) in payment ofwhich the Board of Supervisors caused
the Warrant No. 003400004646 to be iiked on 08/23/2013, drawn on the
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 prays that the Board of Supervisors issue to him/her a
duplicate of said Warrant No.00340004646 in the sum of $ 374.04.
Signed:
64,k -...4{V> .5 4i
Subscribed and sworn to before me this day of RIrraww_a2)i-1
;.L ! • n
Notary COMM. Public #1913767 - California z -;•Q
Comm. Stanislaus Expires County Nov. 19, 2014 -
NOTARY PUBLIC
My commission expires:
Return original signed, notarized form to:
Maricopa County-Risk Management Dept.
222 N. Central Avenue, St., #1110
Phoenix, AZ 85004
AFFIDAVIT
CLERK BOARD OF SUPERVISORS
IIAARICOPA COUNTY
STATE OF ARIZONA
COUNTY OF MARICOPA
Kristen L. Brown, being first sworn, upon oath deposes and says:
That on the 17th day of December, 2013, they presented to Maricopa County, for
payment, a claim for services rendered or supplies furnished during the month of
November 2013, said claim being in the sum of Five hundred fifty seven and 50/100
dollars, ($557.50) in payment of which the Maricopa County Board Supervisors caused
the Warrant Number 340014538 to be issued on 12/17/13, 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 340014538 in the sum of $557.50.
Signed:
Subscribed and sworn to before me this 2- 1- 0 day of F E6P uA/2 t LI
az,ot,.. no, ) T.' Lit
NOTARY PUBLIC
My commission expires: NABANITA PATNA1K
Notary Public
State ot New Jersey
My Commission Expires Oct 3, 2016
%lab \ :rc\A vit FrIrm
Revised March 2007 ms
2/5/2014 11:47:28 AM
AFFIDAVIT/NOTICE OF CLAIM
at*, 'e. BO/ v0 OF SUPERVISORS
STATE OF ARIZONA MARICOPA COUNTY'
COUNTY OF MARICOPA
David M Burke BEING FIRST DULY SWORN
OATH, DEPOSES AND SAYS:
That on the 19th day of February , 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
Eleven Hundred Eighteen dollars and 80/100
Dollars ($1,118.80 ) in payment of which the Board of Supervisors caused the
Warrant No. 22162107 to be issued on _February 12 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. 22162107 In the sum of11,118.80
Dated: 02 ,20 Signed:
Affiant
***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the
replacement check.***
Subscribed and sworn to before me this I CI day of F-E-10 , 20
01.4.A4 -RNicue)
OFFICIAL sEAINotar4 Public
My commission expire ..'ab EILEEN WILLIAMS-PREAS -
. % I+ sl• NOTARY MARICOPA PUBLIC - COUNTY State of Arizona
rieD 1 11. 11.....;..7......Riy \Ali lir!. Comm. Expires Nov. 9, 2014
UPON APPROVAL. PLEASE MAIL REPLACEMENT CHECK TO:
01/31/2013
CLERK, BOARD OF SUPERVISORS
MAPICOPA COUNT?
AFFIDAVIT/NOTICE OF CLAIM
STATE OF ARIZONA
COUNTY OF MARICOPA
ADAM R. RANKIN BEING FIRST DULY SWORN
OATH, DEPOSES AND SAYS:
That on the 23 day of January , 20 14 , he/she
presented to Maricopa County, for payment a claim for services rendered or supplies furnished during the
month of AUGUST 2013 , said claim being in the sum of
TWO HUNDRED AND NINETY-TWO DOLLARS AND NO CENTS
Dollars ($ 292.00 ) in payment of which the Board of Supervisors caused the
Warrant No. 22119725 to be issued on AUGUST 28 , 20 13 , drawn on
the Payroll Clearing Account fwid.
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, aftiant 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. 22119725 In the sum of $ 292.00
Dated: ot-- //d- , 20 / 1/ Signed:
Affiant
***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the
replacement check.***
ed and sworn to before me this O`.1.41ay of felgrAirt e , 2014
My commission expires: k k
UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO:
(11/11/7(111