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AFFIDAVIT APPROVED DATE AUG 04 2013 11A. CC A COL] TY STATE OF ARIZONA COUNTY OF MARICOPA YOUNGTOWN CAFE, being first sworn, upon oath deposes and says: That on the 16TH day of MAY. 2013, they presented to Maricopa County, for payment, a claim for services rendered or supplies furnished during the months of February, 2012 through February,2013, said claim being in the sum of TWO HUNDRED FIFTY AND 00/100 dollars, ($250.00) in payment of which the Maricopa County Board Supervisors caused the Warrant Number 330022776 to be issued on 05116/13. 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 330022776 in the sum of $250.00. Signed: $,Lil*ribed and swornit-opefore me this 9,Cel ‘ day of J1-i\bJa NOTARY PUBLIC My commission expires: YI*4132A GCC4ZALE2 - 1 NOTARY PUBIC - Azzos.* MANCOPA COUNTY W4 Canniirlan flew Mods 24, 2017 11cs1datalFinance$1AP PAYNTORMS107 Affidavit Form Blank.doc Revised March 2007 ms 7/11/2013 9:26:45 AM AFFIDAVIT/NOTICE OF CLAIM STATE OF ARIZONA COUNTY OF MARICOPA -.3 r- 3 MARIA E GUERRA GONZALES BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on the 6TH day of AUGUST , 20 13 he/she presented II? to Maricopa County, for payment a claim for services rendered or supplies furnished during the tr) month of NOVEMBER , said claim being in the sum of ONE HUNDRED FORTY Dollars ($ 140.00 ) in payment of which the Board of Supervisors caused the Warrant No. 22048089 to be issued on DECEMBER 5, . 2012 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. 22048089 In the sum of $ 140.00 Dated: (31--- — 13 ,20 Signed: '14st-ek---rt. A ffi ant ***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the replacement check.*** Noisy PATRICIA pubic .emeiY4rtbe M.. and sworn to before me this ,Z1 day of da..f-z 47‘ , 20 / !AMCOR% COUNTY Consnisstrn Expires May 8.2018 tic e I • %- Notary Public My commission expires: q UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO: Name: _ Telephone Number: Address: Employee ID # Address: 01/31/2013 K, MARICOPA BOARD OP COUNTY SUPERVISORS AFFIDAVIT/NOTICE OF CLAIM !3 AUG 12 Ati 51 PAY STATE OF ARIZONA COUNTY OF MARICOPA BARBARA ANN BARTLETT BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on the 1ST day of AUGUST , 20 13 , he/she presented to Maricopa County, for payment a claim for services rendered or supplies furnished during the month of NOVEMBER , said claim being in the sum of FIVE Dollars ($ 5.00 ) in payment of which the Board of Supervisors caused the Warrant No. 22066022 to be issued on JANUARY 30, , 20 13 , drawn on the Payroll Clearing Account fund. Affi ant 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 WarrantNo. _ , 22066022 In the sum of $ 5.00 Dated: (S , 20 1.3 Signed: Affiant ***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the replacement check.*** Subscribed and sworn to before me this 2_ day of , 200_ Notary Public My commission expires: OFFICIAL SEAL REYNALDO VALENZUELA JR. A-LisosyrAzzol3 Notary MARICOPA Public - State COUNTY of Arizona UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO: My Comm Expires Aug. 29.2013 Name: Telephone Number: Address: Employee ID #: Address: 0131/2013 AP7PROVED 1111 100111 1:1:1111111 FiVISORS AFFIDAVIT/NOTICE OF CLAIM /1171111 ITY STATE OF ARIZONA COUNTY OF MARICOPA BARBARA ANN BARTLETT BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: That on the 1ST day of AUGUST , 20 13 , he/she presented to Maricopa County, for payment a claim for sen-ices rendered or supplies furnished during the month of NOVEMBER , said claim being in the sum of ONE HUNDRED Dollars ($ 100.00 ) in payment of which the Board of Supervisors caused the Warrant No. 22047990 to be issued on DECEMBER 5, ,20 12 , 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. 22047990 Dated: ig Affiant ***A $12.00 fee for the stop payment and reissuance of the warrant will be deducted from the replacement check.*** Subscribed and sworn to before_ me this c?... day of 2013 My commission expires: OFFICIAL SEAL REYNALDO YALENZUELA JR. Notary MARICOPA Public - State COUNTY of Arizona ON APPROVAL, PLEASE MAIL REPLACEMENT CHECK. TO: My Comm. Expires Aug. 29. 2013J Name: Telephone Number: . Address: Employee ID #• Address: 01/31;2013 AFFIDAVIT/NOTICE OF CLAIM STATE OF ARIZONA COUNTY OF MARICOPA MARY FRANCES JOHNSEN BEING FIRST DULY SWORN OATH, DEPOSES AND SAYS: J- That on the 31ST day of JULY , 20 13 he/she presetitg—d to Maricopa County, for payment a claim for services rendered or supplies furnished durin g the month of MARCH , said claim being in the sum of "6 ONE HUNDRED FORTY Dollars ($ 140.00 ) in payment of which the Board of Supervisors caused the Warrant No. 21964478 to be issued on MARCH 14, ,20 12 , 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. 21964478 In the sum of $ 14 00 Dated: , 20 /3 Signed: Affiant ***A $12.00 fee for the stop payment and reissuance of the warrant will be deduaed from the replacement check.*** PATRICIA M. ALLEN *MY Public -8111.00BIalsocrib d and sworn to before me t day ofataral , 20 / 3 co COUNTY /If &Yr/simian Expires MMit 9. 25NI Notary Notary Public My commission expires: cf -711 et.,4 1 UPON APPROVAL, PLEASE MAIL REPLACEMENT CHECK TO: Name: Telephone Null Address: Employee ID # Address: 01/31/2013 AFFIDAVIT STATE OF ARIZONA COUNTY OF MARICOPA Ed Speldy East Company LTD, being first sworn, upon oath deposes and says: That on the 1st day of May 2013, they presented to Maricopa County, for payment, a claim for services rendered or supplies furnished during the month of May 2013 said claim being in the sum of Nine Hundred Forty one and 56/100 dollars, ($941.56) in payment of which the Maricopa County Board of Supervisors caused the Warrant Number 330023204 to be issued on 5123/13, 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 330023204 in the sum of $941.56. Subscribed and sworn to before me this NOTARY PUBLIC 0," cal4 My commission expires: 11cs1datalFinanceMP PAY\ FORMS102 Affidavit Form Blank.doc Revised March 2007 ms 7/31/2013 1:44:58 PM AFFIDAVIT STATE OF ARIZONA COUNTY OF MARICOPA Versata, Inc, being first sworn, upon oath deposes and says: That on the 14th day of June 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 Seven Thousand Five Hundred Forty Two and 59/100 dollars, ($27,542.59) in payment of which the Maricopa County Board Supervisors caused the Warrant Number 330025584 to be issued on 6/24/13, 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. WHEREFOREvaffiant requests that the Board of Supervisors issue to him/her a duplicate of saict'Wa7nt Number 330025584 in the sum of $27,542.59. Signed: ,z( Subscribed and sworn to before me this day of Dei / 2013 . \ vz-Z NOTARY PUBLcIE1 My commission expires: friarci,-- I HILARY ANNE BROWN 1.3444„.71 Notary Public. State of Texas My Commission Expires .7% ; '1F[174;-„ 111440:1 March 15, 2016 Revised March 2007 ms 7/18/2013 1:35:21 PM AFFIDAVIT STATE OF ARIZONA COUNTY OF MARICOPA William Oglesby, being first sworn, upon oath deposes and says: That on the 23rd day of June 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 Two Hundred Seventy Three and 00/100 dollars, ($273.00) in payment of which the Maricopa County Board of Supervisors caused the Warrant Number 340000626 to be issued on 7/5113, 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 requ sts that the Board of Supervisors issue to him/her a duplicate of said Warrant Nu be 340000626 in the sum of $273.00. Signed: Subscribed and swor.19 . o beforffi me this L_J day of Pitus-k- 20 \ NOTARY PUBLIC My commission expires: -ganuar,123 261_1 Nathaniel Weer Notary Public •:'k pu, Or Maricopa County, Arizona My Comm. Expires 01-23-17 llcs1dalz1Finance$1AP PAYWORMS107 Affidavit Form j3lank.doc Revised March 2007 ms 7/31/2013 3:44:39 PM