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AFFIDAVIT/NOTICE OF CLAIM ..•I••I• STATE OF ARIZONA 6P. COUNTY OF MARICOPA r- ' =WNW. itk '50\ e g I4J het S2Atil BEING FIRST DULY SWORN I" c - OATH, DEPOSES AND SAYS: That on the ) day of , 20 if , he/she presented to Maricopa County, for payment a claim for services rendered oi supplies furnished during the month of Nu- lc 1 3— , said claim being in the sum of Dollars ($ 73 , I, 7 ) in payment of which the Board of Supervisors caused the Warrant No. j2 n10104 < to be issued on (-)uP,Aftil 't.o , 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 shown is due and owing. WHEREFORE, affiant requests that the Board of Supervisors issue to him/her a duplicate of said Waffant No. f31 qg ô &Co In the sum of Date& W&i) 1 I , 20 [ 4 Signed: ii '116:C. Oitt Affiant ***A $12.00 fee for the stop payment and reissuance of the warrant will be deduc e replacement check.*** 4-1:11.74s TIFFkINFPFACIV"-- d 1/ v!"0 NOTARY PUBLIC-OREGON COMMISSION NO. 475279 MAISSION - EXPIRES FEBRUARY 03 „ 2011 My commission expires: PINT A DDD nu A A TA A TT A -GAM A r'Ll't A-GIS LTL'OV 'TC1 AFFIDAVIT/NOTICE OF CLAIM STATE OF ARIZONA IDA JAN 28 PH to 39 COUNTY OF MARICOPA MARICOPA COUNTY SEPT. OF ELECTIONS Jodie Jean Swenson BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on the 16th day of December , 20 13 , he/she presented to Maricopa County, for payment a claim for services rendered or supplies furnished during the month of November , said claim being in the sum One Hundred Fifty Five Dollars ($ 155.00 ) in payment of which the Board of Supervisors caused the 7,7 Warrant No. 22047811 to be issued on December 19 , 20 12 , drawn okthe Q , i:,, .V.- 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. 22047811 155.00 Dated: X_AA , 20 14 Signed: ***A ono fee for the stop payment and reiskance of the I be deducted from the replacement check.*** Subscribed and sworn to before pi z this 2,1-I day of . 14.0, My commission expires: 05-ILj . Jonathan Matthew Macias UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO: Notary Public Maricopa County, Arizona Name: _ My Comm. Expires 08-14-17 Address: Address: 4/3/2012