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NOTICE OF CLAIM STATE OF ARIZONA COUNTY OF MARICOPA First Arizona Title, being first sworn, upon oath deposes and says: That on the 12th day of September, 2012, they presented to Maricopa County, for payment, a claim for services rendered or supplies furnished during the year of 2011 said claim being in the sum of Nine hundred sixty five and 13/100 dollars, ($965.13) in payment of which the Maricopa County Board Supervisors caused the Warrant Number 775497 to be issued on 09/12 2012, 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 duplicpte of said Warrant,Niffiber 7 97 in the sum of $965.13. Sign Subscribed and sworn to before me this atu day of -9,e6v44'-ii, „lie/4 My commission expires: _I-471 VICIA OFFICIAL NUNLEY SEAL Notary Public- State °Mims MARICOPA COUNTY I My Comm. Explres Aug. 12,2016 : X\slAtata\a_ c ian.ceS \AP PAY1FORM107 Affidavit Form Bklk.dor Revised March 2007 ms 2/24/2014 8:55:10 AM NOTICE OF CLAIM STATE OF ARIZONA COUNTY OF MARICOPA First Arizona Title being first sworn, upon oath deposes and says: That on the 13th day of September, 2012, they presented to Maricopa County, for payment, a claim for services rendered or supplies furnished during the year of 2011, said claim being in the sum of Six hundred thirty seven and 35/100 dollars, ($637.35) in payment of which the Maricopa County Board Supervisors caused the Warrant Number 775625 to be issued on 09/13/2012, 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 Nuajbw 775625 in the sum of $637.35. Signed( Subscribed and sworn to before me this day of 1(4lue>1 NOTARY PUBLIC My commission expires: Pat VICIA OFFICIAL NUNLEY SEAL Notary Pub1c - State &Arizona 1 MARICOPA COUNTY My Comm. Expires Am. 12,2016 : Ilcs1data \Finanset I AP PAYNFOFtM_07 Affidavit Farm iilnk Revised March 2007 ms 2/24/2014 9:16:56 AM NOTICE OF CLAIM STATE OF ARIZONA COUNTY OF MARICOPA First Arizona Title, being first sworn, upon oath deposes and says: That on the 13th day of September, 2012, they presented to Maricopa County, for payment, a claim for services rendered or supplies furnished during the year of 2011, said claim being in the sum of Seven hundred twenty and 74/100 dollars, ($720.74) in payment of which the Maricopa County Board Supervisors caused the Warrant Number 775639 to be issued on 09/13/12, 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 NipiliAr 775949 in the sum of $720.74. Signe 1,1sAeor2- Subscribed and sworn to before me this e;26-r" day of 7-60-kudivei, go/z/ r 'Oeto( Vial-CIL11 NOTARY PUBLIC OFFICIAL SEAL My commission expires: VICIA NUNLEY Notary Public- State ofAttorta MARICOPA COUNTY ••—••—•.---.•—••••01=1...1.1M•IIMMOMMO My Comm. ExpinmAua.12 2018: llcslclatalFinance$AP PAY1FORMStidaviT031arik.doc Revised March 2007 ms 2/24/2014 9:28:06 AM AFFIDAVIT STATE OF ARIZONA COUNTY OF MARICOPA First Arizona Title, being first sworn, upon oath deposes and says: That on the 13th day of September. 2012, they presented to Maricopa County, for payment, a claim for services rendered or supplies furnished during the year of 2011, said claim being in the sum of Four hundred sixty four and 68/100 dollars, ($464.68) in payment of which the Maricopa County Board Supervisors caused the Warrant Number 775650 to be issued on 09/13/12, 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 Nymtwr 77§§50 in the sum of $464.68. Signed: /A Subscribed and sworn to before me this e96 day of is-ebtudA,--ei oe/4/ VI,a4de NOTARY PUBLIC My commission expires: 4r—LP : .—..—..---.......---..—..—..—..,. ....rim,. OFFICIALSEAL ; VICIA NUNLEY 1 Nobay Pubk - Shiba ciArEaxia I I : ...-..,..., My LIMADRIVGPA Comm. EcirseAug, L"^C'G'IJ"N""fr 1Z 2016; i W:sIdatalFinanceMAP PAYWORMS107 Affidavit Form Riank.doc Revised March 2007 ms 2/24/2014 12:00:45 PM AFFIDAVIT/NOTICE OF CLAIM STATE OF ARIZONA COUNTY OF MARICOPA -11 Zt Leonard Leroy Beardsley BEING FIRST DULY SWORN AP Ct2 OATH, DEPOSES AND SAYS: That on the 4th day of December , 20 13 , he/she prce: ntee ter to Maricopa County, for payment a claim for services rendered or supplies furnished during the month of November , said claim being in the sum of One Hundred Dollars ($, 100.00 ) in payment of which the Board of Supervisors caused the Warrant No. 22045422 to be issued on December 19 .20 12 , drawn on the Payroll Clearing Account fund. Affiant further says that although be/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. 22045422 In the sum of $ .00 Dated: (-9 — ,20 / V Signed: Affi ** ailSEBEE8-festorwatnta1err 014319 rit-nelleiTarTERTITOM-111 repiseanoWelteele*** Subscribed and sworn to before me this day Iettitt'd 20 Kf °fb4 artAk, 9- 1 L4 Notary Public DONNA ANN KISH My commission expires: Nola" y Public - State of Aiken,* My Comm. MARICOPA Expires COUNTY Sept. 14, 20114 UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO: UI/J1/GUI.5