DUPLICATE WARRANTS PAYROLL.PDF

AFFIDAVIT/NOTICE OF CLAIM
?ROVED
STATE OF ARIZONA 24 2013
COUNTY OF MARICOPA
ERIC, 60N-iv ARICOPA ur COUNTY
3C. k) BEING FIRST DULY SWORN
OATH, DEPOSES AND SAYS:
That on the a.-2, day of , 20 R , 6e/she presented
to Maricopa County, for payment a claim for services rendered or supplies furnished during the
month of f6V-J V S , said claim being in the sum of
Dollars ($ 530 0--, ) in payment of which the Board of Super isors caused the
Warrant No. 2/2-1 kc‘3 to be issued on A, - ) , 20 k'S , 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. 22.l \ 4 In the sum of $ 53 0 , c4.>
Dated: C(' IL 3 1 I -5 ,20 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 23 day of , 20 1 3
cfamparvs A k
blic OFFICIAL SEAL
My commission expires: EILEEN WILLIAMS-PREAS
NOTARY PUBLIC - State of Arizona
II. ( -2prt-i- My Comm. MARICOPA Expires COUNTY Nov. 9, 2014
UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO:
Name: `3(oce.„4.,0 a Ley
Address:
Address:
01/31 2013

AFFIDAVIT/NOTICE OF CLAIM
STATE OF ARIZONA 13 SEP 26 PH 3:14
COUNTY OF MARICOPA 1.01.1./RECORPS
7 BEING FIRST DULY SWORN
OATH, DEPOSES AND SAYS:
That on the i.:.)6,.., day of , C.', )::.1 1 ,ii," (4f.:,I-• , 20 / -.7.- —1, he/she presented
_
to Maricopa County, for payment a claim for services rendered or supplies furnished during the
---,
month of 3,-ti, c , .,-- --,t,,.... .„. ,, L,„_.. c -„ ,.,-. , said claim being in the sum of
Dollars ($ ) in payment of which the Board of Supervisors caused the
Warrant No. 93 c.. ,0 if to be issued on 4-7 - 20 drawn on the
I
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. 9997ç In the su
.
Dated: s_)J../.,), ,20 72-...) Signed:
A ffi an t
***A $12.00 fee for the stop payment and reissnance of the warrant will be deducted from the
replacement check.***
Subscribed and sworn to before me this a 5- day of 20 P)
S.'Tt—)RTIA M. Wivifv1/4
Note/ Put* - State or AritOIVI Notary lie
My coi xpirCR1COPACC/14TI
June 16, 2017
UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO:
Name: _ Telephone Numberl
Address: Employee ID #:
Address:
01/31/2013

€ I4
AFFIDAVIT/NOTICE OF CLAIM
4,1 P 11
STATE OF ARIZONA 17 2013
rAi.42
COUNTY OF MARICOPA
I MARCO PA COUNTY
3C010onl ,e_ BEING FIRST DULY SWORN 2ig
OATH, DEPOSES AND SAYS:
That on the (.941 day of_:--Y ,i421ed&kgIE , 20 / 5 , he/she presented
to Maricopa County, for payment a claim for services rendered or supplies furnished during the
month of )36 12D I:3 • said claim being in the sum of
.-+IAC, \AkkA C k (I 0Wel-CS'
Dollars (S (y) ) in payment of which the Board of Supervisors caused the
Warrant No. 0012_I I g,4 to be issued on , 20 1 .5 , 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. 00 2:2_ c'tc(ac4 In the sum of S9.L.62 0 0
Dated: Atiqths.- 20 3 Signed:
ATfiant
***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the
replacement check.***
, ,,, I K. 1 ,,,,,
Subscribed-dr*, ', S.. S1`..), SWOrii 10. S t
: T I NOTARY PUBLIC
= : * i 1 Notary Public
My ,_ c nun ion expires: "::. '-.. N o 12-191 ..I _
geke %,, 6);'''' . ,,, ..•,,....\--':
,
UPON APPROVAL, PLEASE M AIL; VEPLACEMENT CHECK TO:
01/31/2013

z05-1
AFFIDAVIT/NOTICE OF CLAIM
A‘,, s
STATE OF ARIZONA le SS
Sfii 21
COUNTY OF MARICOP 10110-1,1.1RECORIS
BOAR OF S P RVIS
COUNTY -j
Lbo U G(ii s 5 . -roc /KT* BEING FIRST DULY SWORN
OATH, DEPOSES AND SAYS:
That on the day of , 20 , he/she presented
to Maricopa County, for payment a claim for services rendered or supplies furnished during the
month of , said claim being in the sum of
FOUR 1a 5r CNC' bc I I kE 4 (WOO
Dollars ($ 2.1,04 ) in payment of which the Board of Supervisors caused the
Warrant No. 22, I I gS' to be issued on g — 2g , 20 I 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. 2211 s-gs--0 In the sum of $ o()
040::
Dated: 9 20 , 20 13 Signed:
Aft
***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 thisk-W 20
tary Public
My commission expires: of JESSICA P MCQUAID
(c. Notary Public - Arizona
.2jJAAL (1 Yavapai County
UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO:1 My Comm. Expires Jun 14, 2016
01/31/2013

AFFIDAVIT/NOTICE OF CLAIM
STATE OF ARIZONA
OCT 1 2013
COUNTY OF MARICOPA
RK, ,IOAR15-05F SrpirfiVISCRS- r 1
MAROOPA COUNTY
BEING FIRST DULY SWORN to?
OATH, DEPOSES AND SAYS: EiP 4f) 42
That on the 3?) day of seipie–rkt–bz,l__ , 20 4.5 , -he/she presented
to Maricopa County, for payment a claim for services rendered or supplies furnished during the
month of , said claim being in the sum of
hAmcii Se-ix-4-ft 7 -44-1, AittatKs a 4,,eL .2444
Dollars ($ 374 (9 ) in payment of which the Board of Supervisors caused the
Warrant No. a 1 ? /6—, to be issued on deS' , 20 k3 , 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. 4-24 /7,59 In the sum ofe$2_
Dated: _SF-'1414--diA,q2A. So, 20 13 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 ta° day of 20 13
2.--LialtoLcaaa,-2a,u,„6
Ndt ic OFFICIAL SEAL
My commission expires: EILEEN WILL1AMS-PREAS
NOTARY PUBLIC - State of Arizona
k I - ct •20 A I ''.. .—W, My Comm. MAR1COPA Expires COUNTY Nov. 9, 2014
UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO:
01/31/2013

AFFIDAVIT
A IP 11 ATE 021 v
EP 2 5 2013
CLERK, BOARD OF SUPER1(180a5
MARIOOPA COUNTY
STATE OF ARIZONA
COUNTY OF MARICOPA
Arizona State University, being first sworn, upon oath deposes and says:
That on the 1st day of July 2013, they presented to Maricopa County, for payment, a
claim for services rendered or supplies furnished during the month of June 2013, said
claim being in the sum of Twenty Five Thousand and 00/100 dollars, ($25,000) in
payment of which the Maricopa County Board of Supervisors caused the Warrant
Number 340000877 to be issued on 7/9/13, 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 "nt N' 40000877 in the sum of $25,000.
Signed:
Subscribe and sworn to before me this day of
NOTARY PUBLIC MIRANDA PRATT
Notary Public - State of Arizona
My commission expires: 2--/ 61/I to My mARICOPA Commission COUNTY Evires
February 9.2016
Wsldata Finance$1AP PAYIFORMS107 Affidavit Form Blank.doc
Revised March 2007 ms
9/18/2013 4:28:46 PM

AFFIDAVIT
STATE OF ARIZONA,
COUNTY OF MARICOPA
Arnold Turer being first sworn, upon oath deposes and says:
That on the 9th day of September, 2013 , Maricopa County agreed to an
Indemnity payment, in the sum of one thousand and twelve dollars, ($1,012.00),
in payment of which the Board of Supervisors caused the Warrant No.
AD00340006036 to be issued on September 9, 2013, drawn on the Expense
Fund.
Affiant further say that although they were informed and believe that the above
mentioned warrant was regularly issued, the same has never been received, or
has been lost.
Wherefore, affiants pray that the Board of Supervisors issue to them a duplicate
of said Warrant No.AD 00340006036 in the sum of $1,012.00
Signed:
Subscribed and sworn to before me this ogday of n5p-i- D
My commission expires: 9/04//3 KIM ARLINE MITA
Notary Public - State of New YOrk
NO. 01M16234349
Qualified in Orange Caulk
Return original signed, notarized form to: My Commission Expires 1.11
Maricopa County-Risk Management Dept.
222 N. Central Avenue, St., #1110
Phoenix, AZ 85004

APPROVZAD
AFFIDAVIT
STATE OF ARIZONA, RK, MARICOPA BOARD OF COUNTY SUPERVISORS
COUNTY OF MARICOPA
Consepcion Ortiz, being first sworn, upon oath deposes and says:
That on the 24th day of September, 2013 , Maricopa County agreed to an
Indemnity payment, in the sum of nine hundred thirteen and 28/100 dollars, ($
913.28, in payment of which the Board of Supervisors caused the Warrant
No.AD 00340007502 to be issued on September 24 , 2013, drawn on the
Expense Fund.
Affiant further say that although they were informed and believe that the above
mentioned warrant was regularly issued, the same has never been received, or
has been lost.
Wherefore, affiants pray that the Board of Supervisors issue to them a duplicate
of said Warrant No.AD 00340007502 in the sum of $913.28
Signed:
Subscribed and sworn to before me this
....yr / A
My commission expires: 4-a10 (34 QOi '7
Return original signed, notarized form to: SAMANTHA Notary Public A RAMIREZ - Arizona
Maricopa County-Risk Management Dept. WOW Coo*
222 N. Central Avenue, St., #1110 My Comm. Expires Feb 9,2017
Phoenix, AZ 85004

0 3 2013
AFFIDAVIT/NOTICE OF CLAIM
CLERK, BOARD OF S LIDE RVIS CRS
141.4.1,1G0FA COUNTY
STATE OF ARIZONA
474
COUNTY OF MARICOPA
. -13ek kLyloriTe BEING FIRST DULY SWORN wow.
rr
OATH, DEPOSES AND SAYS: C.
That on the day of iljotine r , 20 V3 , he/she preatedia
to Maricopa County, for payment a claim for services rendered or supplies furnished during the
month of 5, ejr‘ Moe_ ( a 1?) , said claim being in the sum of
Dollars ($ LkCk . if ) in payment of which the Board of Supervisors caused the
Warrant No. ;")-)3;) I ,-;,(15),(41 to be issued on , 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. (I)Dt9Q In the sum of $ 7LcXL%
Dated: k ,20 1 .-5 Signed: LLd 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 befo zthis LSI— day of thitL 20
A
10
1/4
My omni1ission expires: PRISCILLA OFFICIAL R GALBAN SEAL
a *CLARY RELIC - STATE% ARM
/P4 9-96 Comm. MARICOPA Expires COUN1Y Nov. 12,2015
UP N APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO:
Name:
Address:
Address:
01/31/2013
.24// 'SF

AFFIDAVIT/NOTICE OF CLAIM
APPROVED
STATE OF ARIZONA (1C1 O.3 20,13,
COUNTY OF MARICOPA
CLERK, BOARD OF SUPEF.VISOFS
MARICOPA COUNTY
BEING FIRST DULY SWORN
t 1')
OATH, DEPOSES AND SAYS:
That on the _Aeb day of _A r- , 20 , he/she presented
to Maricopa County, for payment a claim for services rendered or supplies furnished during the
month of 2,613 , said claim being in the sum of
Dollars ($ OA ) in payment of which the Board of Supervisors caused the
Warrant No. 2.2.4.,(9 14-3 to be issued on , 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. 7;61, 2_19 In the sum of $
Dated: \, kb''‘ , 20 \,3 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 2- day of , 20 13
titCat/mo --Pfus:L6
Notary Public OFFICIAL SEAL
My commission expires: ( .(:,,:9- EILEEN WILLIAMS-PREAS
:-..,-. NOTARY PUBLIC - State of Arizona
11.1 01.2014 \ „....1I122o. My Comm. MARICOPA Expires COUNTY Nov. 9, 2014
APPYR.0"VrAL " "PYL"EA—S-E MAI " " "L RE -" -Pri,ACE-M-E-NT± 'Cr-i'EC1k

AFFIDAVIT/NOTICE OF CLAIM
STATE OF ARIZONA AK, BOARD OF SUPERMS CRS
AAAFOCO PA COUNTY
COUNTY OF MARICOPA
' -0
4'3Q te:.
/qiw&,tc/ BEING FIRST DULY SWORN1
r I
OATH, DEPOSES AND SAYS:
..:, rri
That on the / day of Ye/2/e/.4.614,-- , 20/3 , he/she prised
to Maricopa County, for payment a claim for services rendered or supplies furnished duripg the L'al
xf ,
month of , `)e()/ airli#1- , said claim being in the surniy
(:,4(-- 4 c fid ) (-: d se 6.6,_i 27/ y - ,_54? L e J?
Dollars ($ /77 d?') ) in payment of which the Board of Supervisors caused the
Warrant No. to be issued on \emb,-_-,,,- 1, 20/ 5 , drawn on the
P--1--Ld
Payroll Clearing Account fund.
Afftant 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. .t.2 /) In the sum of $ /77
Dated: 9 // ,20 /3 Signed:L!
Affiant
***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the
replacement cheek.***
Subscribed and sworn to before me this 2.5 day of
Ma Dolores P &dull°
My commission expires: o>riby 11-0 e NOTARY MAR:COPA PUBLIC COUNTY -ARIZONA
My Commission Expires
March 04, 2014
UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO:
4/3/2012

r
A ilig tolega
EMI„:Xr_
D ,Iffe4,4
PM,25'-/Y
CLE , BOAROF D 9UPERVI
MARICOPA COUNTY
August 9, 2013'
Maricopa County Animal Care & Control
Licensing Division
P.O. Box 2959
Phoenix, AZ 85062
H. Lee Mitchell
8714 E. Sage Drive
Scottsdale, AZ 85250
(Can't use phone re disability)
Sirs:
iis is a to-part requost It is about my neutered brown and white Australian cattle dog, Neo.
license numoer is 4 313478 end his microchip iium;Jer is 0A10234275. He is about six years old. lam a
sAior, age seventy, with bo::1 vision and hecring problems.
Eair t;ile year, in late Mardi or in Apr, you sent me a refund check for twenty-four dollars. It was
accidently destroyod beiore it could be documented and cashed. I hereby requoot that it be reissued.
For several rozzons, I need a simple letter documenting that my dog Noo is legitimately registered as a
service animal ‘Ath tie County and the date if was so registred. Thia is the part oi the request on which
the timing is most critical.
I hereby vacs and affirm CI of tho information abovo,
Than% you for your prompt aaantion and consideration.