Extracted text (via pymupdf_layout)
2686 characters
AFFIDAVIT STATE OF ARIZONA COUNTY OF MARICOPA PARADISE VALLEY SEPTIC SERVICE, being first sworn, upon oath deposes and says: That on the 9th day of August, 2012, they presented to Maricopa County, for payment, a claim for services rendered or supplies furnished during the month of June 2012 said claim being in the sum of One thousand ten and 00/100 dollars, ($1,010.00) in payment of which the Maricopa County Board Supervisors caused the Warrant Number 330002935 to be issued on 08/09/12, 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 rtguests that the Board of Supervisors issue to him/her a duplicate of said Warr 5 in the sum of $1.010.00. Signed: Subscribed and sworn to before me this lec2day of NOTARY PUBLIC My commission expires: OFFICIAL SEAL 4.11: '•z\ BRIANA GARZELLONI mc-31:} , Notary Pubac • State of Arizona ,L MARICOPA COUNTY IlcsiclataVinancellAP PAYNFORMS107 Affidavit Form_Blanis.doc • 1-.1101PPRIPPIIIIIIMIN My Comm. Expires AprI114, 2017 Revised March 2007 ins 6/20/2013 1:15:59 PM AFFIDAVIT/NOTICE OF CLAIM CLERK, MARICOPA BOARD OF COUNTY SUPERVISORS STATE OF ARIZONA 7813AUG 13 PM 3:02 COUNTY OF MARICOPA MARICOPA COUNTY DEPT. OF ELECTISNS EMILY SILLANPAA BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on the 15TH day of MAY , 20 13 , he/she presented -"a to Maricopa County, for payment a claim for services rendered or supplies furnished during GI .,. , 71 month of MARCH , said claim being in the sum of !'.. G-1 • - •••••• ONE HUNDRED FIFTEEN -m• Dollars ($ 115.00 ) in payment of which the Board of Supervisors caused the • € v r`a • • Warrant No. 21964186 to be issued on MARCH 14 , 20 12 , dravitt)on thd 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. 21964186 Dated: Fl 0 , 20 13 Signed: Affiant 04)2.00 fee for the stop payment and reissuance of the Warrant will be deducted from the Int check.*** *47 0 .4r-u-to 0 Z k'=.wxJ 1. • : 0 I' Subscribed and sworn to before me -- (.0 #4, COUN14 "lvly commission expires: UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO: Name: IT i(y) p'kii 7 (A Telephone Number: Address: 2 r ( L Employee ID #: 811106656 Address: f :-.`; L' 01/31/2013