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AFFIDAVIT/NOTICE OF CLAIM _ A le' lit 0 V i; STATE OF ARIZONA DATE Aug 30 2013 -at ••• COUNTY OF MARICOPA 6c146„,, 1/#,f BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on the RI 0 day of , 20 1 7, he/she presented to Maricopa County, for payment a claim for services rendered or supplies furnished during the month of Iv // _070/J , said claim being in the sum of 6.4 e -Alpe 4-4 Dollars ($ 33. ) in payment of which the Board of Supervisors caused the Wan-ant No. 00,0Z/t/ 3-ds--- to be issued on SO ty TI , 20 / 7 , drawn on the Payroll Clearing Account fund. Affrant 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. 0 Oproi // 7.11)— In the sum of $ 5,r . Dated: 410; 74,C) , 20/ 7 Signed: Alf f ntA*7' r="1"""'"TREIZI--"' EAL weigaatie DEBRA E. Stateimitwodiand TA SLHUT sworn to before me ORA CourThe My Comm. &rims May 5.2015 My commission expires: UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO: Name: Telephone Number: Address: Address: 7/23/2010 AFFIDAVIT FOR WARRANT#330006846 APPROVED DATE SEP 0\3 2013 STATE OF ARIZONA COUNTY OF MARICOPA azAk, MARICOPAJt:TY Baal:MIS _ KIMBERLY MICHELLE WESTER being first sworn, upon oath deposes and says: That on 9/12112 presented to Maricopa County, for payment, Reimbursement for :MED:CAL EXPENSES . In the Amount of: Five Hundred Sixteen Dollars and Three Cents. In payment of which the Board of Supervisors caused the Warrant No. 330003846 to be issued on V2/1/12 drawn on the Expense Fund. Affidavit 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 No. 3305843 in the sum of $515.33 Lye Signed: mberly Michel ester Subscribed and sworn to before me this day of August , 2013 My commission expires:Cya 30, dol(c, NOTARY PUBLIC OFFICIAL SEAL DEANNA J. MEDRANO NOTARY PUBLIC-ARIZONA PINAL COUNTY I My Commission Bq3ires April 30, 2016 I AFFIDAVIT AL YPIZOVE:11 ONT14011-134 ek" Ir 'rjr 77=7 MAFIICOPA COUNTY STATE OF ARIZONA COUNTY OF MARICOPA American Diabetes Association, being first sworn, upon oath deposes and says: That on the 9th day of April , 2013, they presented to Maricopa County, for payment, a claim for services rendered or supplies furnished during the months of February and March 2013, said claim being in the sum of Two thousand five hundred and 00/100 dollars, ($2,500.00) in payment of which the Maricopa County Board Supervisors caused the Warrant Number 330020043 to be issued on 04/09/13, 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 0200 in the sum of $$2,500.00. Signe scrped and sworn to before me this 2Le day of I,,\•.\ t \-V1/40L. NOTARY PUBLIC My commission expires: Ilcs1data Vinance$ \AP PAYWORMS107 Affidavit Form Blank.dog Revised March 2007 ms 7/25/2013 1:03:33 PM AFFIDAVIT APPROVED DATE SEM 4 2013 STATE OF ARIZONA COUNTY OF MARICOPA Chandler Unified School District #80, being first sworn upon oath, deposes and says: That on the 6th day of June 2013, they presented to Maricopa County, for payment, a claim for services rendered during the month of May 2013, said claim being in the sum of eleven thousand seven hundred ninety-four dollars and fifty-eight cents ($11,794.58), in payment of which the Maricopa County Board of Supervisors caused the Warrant Number 00330024491 to be issued on 06/10/2013 drawn on the County's Expense Fund. Affidavit 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 00330024491 in the sum of $11,794.58. Signed: Laet,61.- Subscribed and sworn to before me this c23'--1 day of a,“ o o""Q. NOTARY PUBLIC My commission expires: 30 cv COVUD AFFIDAVIT/NOTICE OF CLAIM SE 0 4 2013 1 2_ n STATE OF ARIZONA COUNTY OF NIARICOPA (ep e Icunc BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on the 9 day of 370- , 20 , h to Maricopa County, for payment a claim for services rendered or supplies furnished during the month of Sep /-cryl J C , said claim being in the sum of 7ivey21qf rot; /- dollar-Ls . --'j-e) Dollars ($ ) in payment of which the Board of Supervisors caused the Warrant No. da ?% 4140 to be issued on Alotit.t54'95? , 20 )3 , drawn oil 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) 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. (IQ 1a0 (PO In the sum of $ c 67) Dated: -71 isep+ , 20 /3 Signed: Affiant ***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the replacement check.*** Subscribed and sworn to before me this day of 2013 Notary Public My commission expires: i1_g. -2A)) 11- EILEEN OFFICIAL WILLIAMS-PREAS SEAL NOTARY PUBLIC -State of Arizona MARICOPA COUNTY UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK luc= t..ma tt Explris Nov. 9, 2014 Name: _ Address: Address: 01,3 1/2013 AFFIDAVIT/NOTICE OF CLAIM APPROVED DATE STATE OF ARIZONA WARD OF SUPERVISORS COUNTY OF MARICOPA MAIR1COPA COUNTY ‘ tvi,or\LD y TO BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on the 4 day of Cirfekvik& , 20 13 he/she presented to Maricopa County, for payment a claim for services rendered or supplies furnished durin g the month of illit()Irt , said claim being in the sum of tV14.-MAnt 5rvort Yth -ith)-(tve. cold Dollars ($ I -2cA/75. ) in payment of which the Board of Supervisors caused the Warrant Nod-20-10 gl to be issued on ,2P8 , 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 penalt y of perjury, affiant hereby affirms that this claim is correct and the amount shown is due and owin g. WHEREFORE, affiant requests that the Board of Supervisors issue to him/her a duplicate of said Warrant No. API? 658-7 In the sum of $ -7 . Dated: q- q. (3 , 20 Signed: Aff#1t ***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 1-4 day of 2013 Notary Public Public My commission expires: 11- OFFICIAL SEAL. EILEEN WILLIAMS-PREAS NOTARY PUBLIC State of Arizona MARICOPA COUNTY UPON APPROVAL, PLEASE MAIL REPLACEMENT CH My Comm. Ears Nov. 9, 2014 Name: _ Address Address 01/3112U13 AFFIDAVIT 20131M 29 P.i 3:53 STATE OF ARIZONA CLERK, tAARICOPf, 30ARD OF COUNTY SUPERVISORS COUNTY OF MARICOPA CAVE CREEK USD # 93, being first sworn, upon oath deposes and says: That on the 2nd day of April 2013, they presented to Maricopa County, for payment, a claim for services rendered or supplies furnished during the month of April 2013, said claim being in the sum of Fifteen Hundred and 00/100 dollars, ($1,500.00) in payment of which the Maricopa County Board of Supervisors caused the Warrant Number 3300021583 to be issued on 5/1/13, 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 Wabrant Number 330021583 in the sum of $1,500.00. , 1 I Signed: Subscribed and sworn to before me this day of /U( 1''7 c oLs 74,az ) NOTARY ElA BLIC My commission expires: 17') 1-9-12r,/-1 4, ,9 JENNIE P CACCIOT11 Notary Public - Arizona Madcap' County My Comm. Expires Mar 4, 2014 llcsldatalFinangetlAP PAY1FORMS107 Affidavit Form Blank.doc Revised March 2007 ms 8/7/2013 3:57:48 PM