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_ ' te".7.41 I AFFIDAVIT/NOTICE OF CLAIM F.OARD SI_ STATE OF ARIZONA AP. COUNTY OF MARICOPA A ta.1 ea J. BEING FIRST DULY SWORAii OATH, DEPOSES AND SAYS: tr, That on the '3 day of Jet t4u4,-%_( , 20"7 he/she prefilter to Marieopa County, for payment a claim for services rendered or supplies furnished during the month of said claim being in the sum of v-Pai S. or Dollars ($ 7(0 ) in payment of which the Board of Supervisors caused the Warrant No. ,,P.2 / to be issued on 4,,sw 11 De , 20 12? , 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. ;2 2/Ra C., 3 In the sum of $ 7(4 Dated: Jetw,Avi I , 20 Pi Signed r Affiant ***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the replacement check.*** Subscribed and sworn to before me this 3 day of siOLAA. , 20 IA ?4)3 aculvA Notary Publi To OFFICIAL SEAL My commission expires: -CA1CALt EILEEN WILLIAMS-PREAS NOTARY PUBLIC - State 0 Arizona MARICOPA COUNTY My Comm, Expires Nov. 9, 2014 UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK : 01/31/2013 A 1? :.; VT-47p4 ,- 1D)le - AFFIDAVIT/NOTICE OF CLAIM FT BBH,11)) 1111.. 00=i+SS ft.LIJITTYY STATE OF ARIZONA COUNTY OF MARICOPA canAosdic1 3 SwQ4450-A BEING FIRST DULY SWORN, • OATH, DEPOSES AND SAYS: - , , c.- That on the /0 44.1. day of sYzLet.v Vta. , 20 he/she presenjed V to Maricopa County, for payment a claim for services rendered or supplies furnished during the c„) month of / S / /3 , said claim being in the sum of -;,-) cm) Et 5 k 4- i-lovioLogi 1-37,-/=,„ Dollars ($ S I ES 1 ) in payment of which the Board of Supervisors caused the Warrant No. 0 ere' 1 51443 to be issued on 2 - 3 , 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, affi ant requests that the Board of Supervisors issue to him/her a duplicate of said Warrant No.0c) 22 '4 4 '4 3In the sum of $ efiliazi,s3/ct. Dated: /0 ,20 1 4 Signed: Affiant ***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the replacement check.*** ERIKA RENO Notary Public,State of Arizona Marloopa County Sub cribed and sworn to before me this / day ofi4l1ontit; 20 I L i My Commission Expires April 22,2018 6-catilL Notary Public My commission expires: (106 e ;)Mi UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO: , buP ,Flu .[ uF UPEFTVIS CRS AFFIDAVIT/NOTICE OF CLAIM MARICOPA COUNTY STATE OF ARIZONA COUNTY OF MARICOPA 41D (2—O N NA ti iJZ BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on the tr" day of 71-ArNk/114-,1 , 20 )1 q , he/she presented to Maricopa County, for payment a claim for services rendered or supplies furnished during the month of Akg71157- 20 i , said claim being in the sum of 1c1. ,u Dollars ($ iletau ) in payment of which the Board of Supervisors caused the Warrant No. 2 2.4 2 2 2 to be issued on A-ITGUST, 2- i( ,20 1 •'-?, , 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. 2.:1‘ 2-72`; 2 In the sum of $ 1 1 9 c" Dated: akfq kiPc-P-1 , 20 .1 1-4 Signed: Affiant ***A $12.00 fee for the stop payment and reissuance of the warrant will be d - icted from the replacement check.*** Subscribed and sworn to before me this I b day of ci O-'ø-. , 20 I q • Pug IC rWILLIAIS-PREAS 7 L-7-6 -*Ai:74' EILEEN NOTARY PURA - State of NUM iol. 4> Comm, MA AR1COP Expires COUNTY Nov. 9, 2014 UPON APPROVAL, PLEASE MAIL REPLACEMENT eflEttrrOrn- AFFIDAVIT/NOTICE OF CLAIM STATE OF ARIZONA COUNTY OF MARICOPA r-- rn ••"1:3 BEING FIRST DULY SWORN c--) C.) r*. ) OATH, DEPOSES AND SAYS: CO 7'7, i • That on the 7C )16- day of /t_C-c e-c , 20 he/she presented to Maricopa County, for payment a claim for services rendered or supplies furnished during the month of \,.•/ e.i. -/-, 64- ,i--/- _./ , said claim being in the sum of --iunt id) )E1 v e_ ci Lb' (t. ) (14A/ ) ( Dollars ($ (,.) /f;- ) in payment of which the Board of Supervisors caused the Warrant No ( 44c/L/ to be issued on 6 - , 20 / 3 , 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.3 (J00C It Si 44 In the sum of $ _.—..._Iar , or. / , Dated: ha ,20 / "7/ Signed: /(..._ 1,A, /"X_ ,_ 3 --tke., .- 5------'---I Affiant ***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the replacement check.*** 17.1.1.01ordla....3,411wALT,arDOWIIIIIVralrutPI "mrl- JACQUELINE OLVenigs ibed and sworn to before me this k 0 day of — 204_ NOTARY PUBLIC - ARIZONA etrioemiruilibuin 14144&airincot•pa pa CoHinnyy CE4g niourive .gre.4, f ) Apt 27,2017 N y Public My commission expires: A 2-71 2-ot / UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO: 01/31/2013 AFFIDAVIT .Ctef RK, MARICOPA COUNTY STATE OF ARIZONA COUNTY OF MARICOPA Rhonda Lauren Kuettel, being first sworn, upon oath deposes and says: That on the 21st day of October, 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 Nineteen and 18/100 dollars, ($19.18) in payment of which the Maricopa County Board Supervisors caused the Warrant Number 340009557 to be issued on 10121/13, 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 340009557 in the sum of $19.18. Signed: -121 Subscribed and sworn to before me this 30-H\ day ofac&rib-er nib NOTARY PUBLIC My commission expires: Y1 1(11 12011 Rachel Chan Notary Public Maricopa County, Arizona My Comm. Expires 07-07-17 11c51data Finance$1AP PAY\FORMS107 Affidavit Form Blank.doc Revised March 2007 ms 12/26/2013 9:34:15 AM AFFIDAVIT ;IrronovraD OAT _ Elle r EOARD OF SUPEIRMSORS MARICCDA COUNTY STATE OF ARIZONA COUNTY OF MARICOPA Yvonne Y Grubbs, being first sworn, upon oath deposes and says: That on the 30th day of December 2013, they presented to Maricopa County, for payment, a claim for services rendered or supplies furnished during the month of December 2013, said claim being in the sum of Thrifty Four and 00/100 dollars, ($34.00) in payment of which the Maricopa County Board of Supervisors caused the Warrant Number 340015756 to be issued on 1/3/14, 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 340015756 in the sum of $34.00. Signed: tit/Yip/Ai Subscribed and sworn to before me this 22 day of 6k(NOC4r 201 (4 \ NOTARY PUBLIC My commission expires: OFFICIAL SEAL CHRISTINA ROMAN-RUIZ Notar7A%tcliMeN/4"*9 My Comm. 'Expires Feb. 25.'2015 Revised March 2007 ms 1/21/2014 1:46:03 PM