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AS Ili. V E 1131 1 t AFFIDAVIT/NOTICE OF CLAIM )/VI .411k. • t. STATE OF ARIZONA COUNTY OF MARICOPA cA) Roberki r A7e4-1,1de BEING FIRST DULY SWORN-I :77 OATH, DEPOSES AND SAYS: Ti C3 -1:0 That on the 9 tr 'day of 1) al t , 20 1,5, he/she prntee -- to Maricopa County, for payment a claim for services rendered or supplies furnished during th ie month of hea&n/L( L Dollars ($ CRP'4 g , 73 ) in payment of which the Board of Supervisors caused the Warrant No.1) a Pi- (4) '1 to be issued on I , 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.(Zi 1/6 Li LH In the sum of $ g 1/3/ '23 Dated: a - of— /3 . 20 013 • Signed: Affiant • ***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the replacement check.*** Subscribed and sworn to before me this ci day of 1)4- ,20 13 :WdaKIVAO --P1utsL4 Notary Pria. My commission expires: OFFICIAL SEAL-77 EILEEN WILLIAMS-PREAS NOTARY PUBLIC - State of Arizona MARICOPA COUNTY UPON APPROVAI, Pr SF, MATT RFPLACFMPNT fly Cornm. expires Nov, 9, 2014 AFFIDAVIT/NOTICE OF CLAIM STATE OF ARIZONA COUNTY OF MARICOPA VELIA URIAS BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on the 5TH day of NOVEMBER , 20 13 he/she presented to Maricopa County, for payment a claim for services rendered or supplies furnished during the month of NOVEMBER , said claim being in the sum of ONE HUNDRED FORTY and NO/100 DOLLARS Dollars ($ 140.00 ) in payment of which the Board of Supervisors caused the Warrant No. 22143701 to be issued on NOVEMBER 20TH , 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. 22143701 In the sum of $ 140.00 Dated: 42.ja.„.j , 204,6_ Signed: My commission expires: LA 070/4" UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO: AFFIDAVIT/NOTICE OF CLAIM OtsiE STATE OF ARIZONA 1 -9 4 \...c..tp--R4,11,1kR,, 0 F; SiZgi3y < COUNTY OF MARICOPA `AARICOFA COUNTY BEING FIRST DULY SWORN no OATH, DEPOSES AND SAYS: / r- rTi That on the daY °f iltLr , 20 , he/she preknte= to Maricopa County, for payment a claim for services rendered or supplies furnished during tin 9? month of k L':\11 .1-Nf--At2cr , said claim being in the sum of Pkcck 1.1(kAy\cv. .t) k Dollars ($ ?6,5 ) in payment of which the Board of Supervisors caused the Warrant No. aa I 1.1 to 353 to be issued on , 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 Warrant No. 07.2./ 4/6 353 In the sum of $ „. 41: i; C. Dated: (1 , 20 1 Signed: Subscribed and sworn to before me this t day of l e—C , 20 3 bmscia"o-Rata..0 Notary Puff, mimmIam., =mom ••II••I My commission expires: EILEEN OFFICIAL WILLIAMS-PREAS SEAL ao t NOTARY MARICOPA PUBLIC - COUNTY State of Arizona My Comm, Expires Nov. 9, 2014 UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO: Name: Address: Address: 7/23/2010 wit AFFIDAVIT/NOTICE OF CLAIM STATE OF ARIZONA , MARICOPA BOARD OF (111ITTYY 1111114/11C(iiiiSS COUNTY OF MARICOPA Ck.v1 e S BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on the I 1 day of Eri 6, v-v-A r , 20 13 he/she presented to Maricopa County, for payment a claim for services rendered or supplies furnished during the month of —1) ,eo ,said claim being in the sum of d 6,70Z4 ded/a./1.12_. a/77d /0 0 Dollars ($ (70, 9 ) in payment of which the Board of Supervisors caused the Warrant No.cca a pi 9'9 7 1 to be issued on , 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 penalt y of perjury, affiant hereby affirms that this claim is correct and the amount shown is due and owin g. WHEREFORE, affiant re quests that the Board of Supervisors issue to him/her a duplicate of said Warrant No.CrA,) 1 I cisq -7 I In the sum of $ Dated: I i ,20 1 -)) 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 C; day of 2013 OFFICIAL SEAL WU214no 440".61 EILEEN WILLIAMS-P. .41.116. NOTARY PUBLIC - State of Arizona otary Public My commission My Comm. MARICOPA Expos COUNTY Nov. 9, 2014 I -^ q• a UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO: Name: _ Telephone Number: Address: Address: 4/3/2012 A $ 4 4P' r ‘. AFFIDAVIT/NOTICE OF CLAIM STATE OF ARIZONA COUNTY OF MARICOPA FRANCISCA OFELIA O'NEILL BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on the 5th day of NOVEMBER , 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 of ONE HUNDRED FIVE and 00/100 DOLLARS Dollars ($ 105.00 ) in payment of which the Board of Supervisors caused the Warrant No. 22142658 to be issued on NOVEMBER 20th 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. 22142658 In the sum of $ 105.00 7.1 Dated: , 20/5 Signed: Affiant" ***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the replacement check.*** Notafy PATRICIA Public - State %AIM of an sworn to before mit-Ibis / day of , 20 Pay Commission MARICOPA Expires COUNTY May g, 2018 Notary Public My commission expires: UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO: Name: _ Telephone Number: Address: Employee ID #: Address: 01/31/2013