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DAT oN 4 2013
AFFIDAVIT/NOTICE OF CLAIM
• uF
MARiGOPA COUNTY
STATE OF ARIZONA 13 OCT
TATE P1112: 41
COUNTY OF MARICOPA HUNAN RESOURCES
C...L.EFK El-ARO OFgERVIS
L MARICOPA NTY
1/80t ( BEING FIRST DULY SWORN
OATH, DEPOSES AND SAYS:
That on the I day of ai-obo --- , 20 15 , he/she presented
to Maricopa County, for payment a claim for services rendered or supplies furnished during the
month of 52i0k-evY)4:1- , said claim being in the sum of
Dollars ($ 00 ) in payment of which the Board of Supervisors caused the
Warrant No. ,PviiNCI,?1,1'3 ')• to be issued on S. 115,20 , 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.c2i)ACG.tia ••I171; (AO ("i
Dated: 0 I , 20 I 2, Sign cQL.L.., - Y)telik </Pe
Affiant
***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the
replacement check.***
Subscribed and sworn to before me this / day of 6d,14- , 20/3
',t1.4C2:..ct..4.4.444pihrieratsadlbult6
Wanda B. Jack
Notary Public - Arizona Notary Public
n County
. 3t,4-)1.4
•
UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO:
AFFIDAVIT/NOTICE OF CLAIM
STATE OF ARIZONA
COUNTY OF MARICOPA k/Afreg2f4
ERK BOARD OF SUPERVISORS
MAFICOPA COUNTY 1:
Robin Stoltze BEING FIRST DULY SWORt .
OATH, DEPOSES AND SAYS: 6,14 cA
That on the i day of C41:1C)C-4". , 20 13 he/she pres'etited
to Maricopa County, for payment a claim for services rendered or supplies furnished during the
month of (.—)0.:k. CI3 ey- , said claim being in the sum of
Dollars ($ 531.00 in payment of which the Board of Supervisors caused the
Warrant No22122132 to be issued on August 18, 2013 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. 22122132 In the sum of $ 531.00
Dated: 0C-1441", , 20 i3 Signed: 12t741 .1)-04—#
Affiant
***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the
replacement check.***
BRENDA DECK sc ed and sworn to before me this ci l'sk day of Oc-A-01:ei , 20u
Notary Publie,Ststs of Arizona
Maricops County
My Commission Expires ek.
June 05, 2016 Notary Public —
My commission expires: z.D.A.A-0.. 5, a ot
TTflIt Y ••-sysrs ell7•T fl •-• 1-11-•rn • v-r•
AFFIDAVIT/NOTICE OF CLAIM
STATE OF ARIZONA i3 ()CI '2
Hum REsouRCES
COUNTY OF MARICOPA
L:Ptc- LU.21(1„s BEING FIRST DULY SWORN
OATH, DEPOSES AND SAYS:
That on the 2 id° — day of __66:AS , 20 t he/she presented
to Maricopa County, for payment a claim for services rendered or supplies furnished during the
month of Eeeigfi.ea2. 20(3 , said claim being in the sum of
TWO THIXAS4 SC-1S) 1444.uto. Ilidriary-A0E" Ant, iKor,
Dollars ($ 7:4-Z t ) in payment of which the Board of Supervisors caused the
Warrant No. 002.2.(2.14gt to be issued on c ariEtosark zc , 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.c02.2-421 cal In the sum of $ .(
Dated: Ocre4E4L t , 20 ( 3 Signed:
Affrant
***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 ca, day of 0 64062/, 20 I
efi.,444...
0/eW
Notary Public
My commission expires: Notary Publ. ERIKA state RENO of Arizona
M f:lunty
0-Pr Li_c2 „,14)\ My Co.nmi:
April 22, 26
AFFIDAVIT FOR COLLECTION OF COMPENSATION FOR PERSONAL
SERVICES OF DECEDENT
sal
STATE OF ARIZONA ) C")
MARICOPA COUNTY !SS.
, 41-14 SgMn174/11ftVAVd
I am signing this affidavit, being first duly s1 orn ay „ • °Ifs:
j
1. INFORMATION ABOUT PERSON WHO DIED: 15).
Name of person who died: 4/#7,:e
Date of death: Sep.—.I 71 7_0/2
Place of death: Maricopa County, Arizona
2.
3. VALUE OF PERSONAL PROPERTY. The value of the compensation for personal services of
the decedent is not in excess of $5000.00.
4. PERSONAL REPRESENTATIVE. To the best of my knowledge, no one has filed an Application or
Petition for Appointment of a Personal Representative and no Application or Petition has been granted in
any state OR if an application has been granted the personal representative has been discharged or more
than one year has elapsed since a closing statement has been filed.
5. This affidavit is made under Arizona Law, Sec. 14-3971(A), Arizq e purpose of
making claim to property of the person who died.
Signature of use or person authorized to act on
behalf of the spouse
SUBSCRIBED AND SWORN TO before me this date: /9/0/ POO , by AECC--744zD6>
c--)r-71
My Commission Expires: OS/044317 Notary Public
Abelardo Frietz
Notary Public
Maricopa County, Artzona
My Comm. Expires 08-04-17
© Superior Court of Arizona in Maricopa County Page 1 PBSE11f
June 17, 2002 Use only most current version
ALL RIGHTS RESERVED
AFF
'PACVED
AFFIDAVIT/NOTICE OF CLAIM TE OCN 5 VI
CLERK, BOARD OF SUPERVISORS
STATE OF ARIZONA ARIOOPF, COUNTY
13 OCT
COUNTY OF MARICOPA I 4Mii 54
ncio,‘ HUNAN RESOURCES
r BEING FIRST DULY SWORN
OATH, DEPOSES AND SAYS:
That on the I (-1 43— day of COAC A-k-C)C-)10 bQQ_ , 20 he/she presented
to Maricopa County, for payment a claim for services rendered or supplies furnished durin g the
month of 0 C Ve±sx2 , said claim being in the sum of
(LI a.6-k
Dollars ($ 5, '1-1 ) in payment of which the Board of Supervisors caused the
Warrant No.Ctgat to be issued on (3Q3k- , cp‘ , 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 re gularly 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.M 73.5 In the sum of $ 4. 1 .7
_
Dated:1)AI , LA , 20 Signed:
***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the
replacement check.***
1
Subscribed and sworn to before me this 1 5 day of 20 13
6
Notary Public
My commission expires: ELVIA DAVIS
Notry Public- Sum °MIRY*
MARICOPA COUNTY
/ Cernmiillon Rotes Feb.11, 2Ot?
UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO:
Name: _ Telephonia...
Address: Employe
Address:
01/31/2013
AFFEDAVIT/NOTICE_DE. CLAIM
I AL6-7,12 1FLOVii.j
STATE OF ARIZONA
COUNTY OF MARICOPA RK, BOARD OF SUPERVISORS
MARICOPA COLINTy
„
/n,7-7c/1//?Ez_. tt/ glZAili ,v.K/A BEING FIRST DULY SWORV ••
=
OATH, DEPOSES AND SAYS: iko
.icr sal
That on the /V day of e ij 20 /3 , 11.he presented
to Maricopa County, for payment a claim for services rendered or supplies furnished during the
month of v-0 .1),(4-- , said claim being in the sum of
CZ/
F--:ve Sevekt /;60
Dollars ($ 5, 7. (:) .-1 ) in payment of which the Board of Supervisors caused the
Warrant No. 221Z:Z1.3","/ to be issued on 07(1-- -)1/4/ 4, 'CI— 21, 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. .2 2 ...3..zes y In the sum of $
Dated: orzra 201 Signed: 77,7v,° 4-1/ • .4'4/
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 I LI" day of (;)t1 , 201S
WLA cktAdO
Notary Publii OFFICIAL SEAL
My commission expires: 11. 01 EILEEN WILLIAMS-PR EAS
NOTARY PUBLIC - State of Atizona
MARICOPA COUNTY
My COMM. Expires Nov. 9, 2014
UPON APPROVAL PLEASE MAIL REPLACEMENT CHECK TO:
01/31/2013