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AFFIDAVIT -7C—CM5721/47 LER iMPIVIS016 - APITG-C-PNCOUNTY.. STATE OF ARIZONA COUNTY OF MARICOPA Deutsch Architecture Group, being first sworn, upon oath deposes and says: That on the 18th day of November, 2013, they presented to Maricopa County, for payment, a claim for services rendered or supplies furnished during the month of October 2013 said claim being in the sum of Twelve thousand one hundred eighteen and 40/100 dollars, ($12,118.40) in payment of which the Maricopa County Board Supervisors caused the Warrant Number 340011873 to be issued on 11/18/13, 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 340011873 in the sum of $12,118.40. Signe Subscribed and sworn to before me this L5 day of cit.-2, /222e, kr' NOTARY PUBLIC BARBARA MACKNIGHT Notary Publia.State of Arizona My commission expires: My Commission Maricope County Expires I October 01, 2016 llcslciatalFinance$NAP PAYWORMS107 Affidavit Form Blank.doc Revised March 2007 ms 2/5/2014 1:16:59 PM P RoyED CLERK, BOARD OF SUPERVISORS AFFIDAVIT MARICOPA COUNTY ------------- FOR W. ---77.7-...7.7.1...=„. .._ 1 - . =:\•=e— ti ty :it a FEB 1 2 2014 STATE OF ARIZONA fey ... COUNTY OF MARICOPA ... AKES FAMILY FUNERAL HOME being first sworn, upon oath deposes and says: That on 113/20 _presented to Maricopa County, for payment, Reimbursement for Funeral Expenses. In the Amount of: Five Hundred Dollars and No Cents. In payment of which the Board of Supervisors caused the Warrant No. 34001' to be issued on 1/31201 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 requests that the Board of Supervisors issue to him/her a duplicate of said Warrant No. 340015799 in the sum of Signed: AIM FAMILY FUNERAL HOME REPRESENTATIVE 51-4.43L CLOLLer,YNLikA Cfpkirz RtihtSid9 Subscribed and sworn to before me this bq day of February , 2014 RuW. uaor, e Ak_faz) pro 4,4Aoc crir VI- erb ei%)% -1-t aNt, a-1 vaSa iabk LpSrva My commission expires: 26-1 NOTARY PUBLIC APP AFFIDAVIT/NOTICE OF CLAIM 444 --- K, BOARD OF COUNTY SUPERVISORS MARICOPA STATE OF ARIZONA 14 FEB COUNTY OF MARICOPA FAYffiLLii;EGOii[IS PATRICK J. BAYSINGER BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on the 31 st day of I 14.47 , 20 Itt &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 THREE HUNDRED AND FIFTY-THREE DOLLARS AND NO CENTS Dollars ($ 353.00 ) in payment of which the Board of Supervisors caused the Warrant No. 22120594 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. 22120594 In the sum of $ 353.00 • Dated: ikLvt 51 , 20 14 Signed: du' AffiantU ***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the replacement check.*** Subscribed and sworn to before me this a/ st day of In toiej, 20 / irecifibbK_ . NW ,c11( OF PE NS A_M Notary Public Kathleen M. Notarial Steamer, Seal Nets/ Public My commission expires: Spring Up., Cesare County ley Commission- Expires Jan. 7, 2018 0;inttarti 2.0iS tumult, PENNSYLVANIA ASSOCIATION CSNOTARIES UPON APPROVAL. PLEASE MAIL REPLACEMENT CHECK TO: 01/31/2013 DAT AFFIDAVIT/NOTICE OF CLAIM CLERK. BOARD OF SUPERVlSORS MAR1COPA STATE OF ARIZONA 4 FEB -5 Ail 8: 45 COUNTY OF MARICOPA PAY•hOLL/d,WCRUS MARISA L. GONZALEZ BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on the 27 day of January , 20 14 , he/she presented to Maricopa County, for payment a claim for services rendered or supplies furnished during the month of AUGUST 2013 , said claim being in the sum of FOUR HUNDRED AND THIRTY-SIX DOLLARS AND NO CENTS Dollars ($ 436.00 ) in payment of which the Board of Supervisors caused the Warrant No. 22122259 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. 22122259 In the sum of $ 436.00 Dated: 0 I4/7 ,20 4 Signed: Affiant ***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the replacement check.*** Subscribed and sworn to before me this a7 day of TgAlgtrif , 20 I My commission expires: UPON APPROVAL PLEASE MAIL REPLACEMENT CHECK TO: 01/31/2013 APPR,OYED DATE A21191211, AFFIDAVIT/NOTICE OF CLAIM CCEIK. BOARD OF SUPE?7,-V-tgC RS STATE OF ARIZONA COUNTY OF MARICOPA ... ...... -In ROBERT L. L1ESKE BEING FIRST DULY SWORN °: rn OATH, DEPOSES AND SAYS: r- --- .:-- That on the 10 day of February ,20 14 f.:' : heafie presented to Maricopa County, for payment a claim for services rendered or supplies furnished Clarineie month of AUGUST 2013 , said claim being in the sufreof TWO HUNDRED AND TWENTY DOLLARS AND NO CENTS Dollars ($ 220.00 ) in payment of which the Board of Supervisors caused the Warrant No. 22120285 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 afrums 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. 22120285 In the sum of $ 220.00 Dated: 2. - I 0 , 20 I L"( Signed: Affiant ***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the replacement checL*** k Subscribed and sworn to before me this /oil- day f f. 6.,-,,c,..4, , 20 i LI ----;/1 I/ otary Public My commission expires: L C ZOO UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO: JAC011 VAX0E0 'UK Notary Public - Atom Miriam Coolly Vilfbirarn. ExpireirJuir 6,201? .„57A1 ti AEL2 ROVE,D tfrn.k. BOARD OF vdal SUPERV:S ORS AFFIDAVIT/NOTICE OF CLAIM !V,!OICOFA COUNTY STATE OF ARIZONA -11 rri COUNTY OF MARICOPA CD L _ Beatriz A Baraias Williams BEING FIRST DULY SWORLIN :71 OATH, DEPOSES AND SAYS: = c.:. That on the day of , 20 14 he/she prc eniell to Maricopa County, for payment a claim for services rendered or supplies furnished during the month of AUGUST 2013 , said claim being in the sum of ONE HUNDRED AND SEVENTY-SIX DOLLARS AND NO CENTS Dollars ($ 176.00 in payment of which the Board of Supervisors caused the Warrant No. 22121670 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. 22121670 In the sum of Dated: - :(30 5 , 20 I tJ11 Signed: Affian ***A $1'2.00 fee for the stop payment and reissuance of the warrant will be deducted from the replacement check.*** Subscribed and sworn to before me this Ly ofteortAf4 IL' MELISSA BETH REYES Notary Public Commonwealth of Virginia Reg. #71,6§1 My Commission Expr, ,Q.01ra UPON APAROVAL PLEASE MAIL REPLACEMENT CHECK TO- 01/31/2013 /i, o /sF AFFIDAVIT/NOTICE OF CLAIM DATE BOARD 0 F SUPERV$SOR3 STATE OF ARIZONA 14AaJ CO PA COUNTY COUNTY OF MARICOPA GUADALUPE FLORES BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on the 5 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 AM) EIGHTY-TWO DOLLARS AND NO CENTS Dollars f$ 282.00 in payment of which the Board of Supervisors caused the Warrant No. 22122192 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. 22122192 In the sum of $ 282.00 Dated: ,a / )-01 cj , 20 ill Signed: ***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 7 ZILdayo( iteimor-y , 20 /1/ My commission expires: UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO: 01/31,2013 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 ....:Msa.taltit . • Z91 State of California di County of 7-- ( 0/14074/ 7 efore me, Date / Here Insert Name am ? Trtle of the Af f / personally a6peared Name(s) of Signer(s) _....) "9 <— who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) isIse- subscribed to the within instrument and acknowledged to me that cirrshetthlior-executed the same in l}igiheritheir authorized capacity(ies), and that by eher/tbeits- signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and offipiarlgal. Signature: Place Notary Seal Above re of Notary Public OPTIONAL Though the information below is not required by law, it may prove valuable to persons rgAring on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Dgc),Ime Title or Type of Document: Document Date: ( Numb r of Pages: Signer(s) Other Than Named Abo Capacity(les) CI ned by/Sirer(s) Signer's Name: i :--1,/;"&gigner's Name: El _Corporate Offi?er Title(s):_ 0 Corporate Officer — Title(s): Individual ILI Individual El Partner — E Limited CI General LI Partner — El Limited El Gen El Attorney in Fact El Attorney in Fact LI Trustee 0 Trustee 0 Guardian or Conservator 0 Guardian or Cosdervator 0 Other: 0 Other: Signer Is Representing: e4-' 42- ()/5 /S-66:-.34 Sign Is Representing: • •—I• es, , •^,,, • M90818(918(6 0Arc: 0 2012 National Notary Association • NationalNotaryorg • 1-800-US NOTARY (1-800-876-6827) Item #5907