Contractor's Final Affidavit and Release of Lien
STATE OF____________ )
) ss
COUNTY OF____________ )
BEFORE ME, the undersigned authority, personally appeared _________, who, after being by me first duly sworn, deposes and says of his personal knowledge that:
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1. |
He/She is________of ________, doing business in the State of Florida (the "Contractor"). |
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2. |
Contractor, pursuant to that certain contract dated________, 20_____ (the "Contract") with________ (the "Owner"), has heretofore furnished or caused to be furnished labor, materials and services for the construction of certain improvements as more particularly set forth in the Contract. |
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3. |
Contractor represents that all work to be performed under the Contract has been fully completed and that all lienors under the direct contract have been paid in full, except the following: |
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Name of Lienor
_____________________
_____________________
_____________________ |
Amount Due
_____________________
_____________________
_____________________ |
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4. |
In consideration of final payment to Contractor in the amount of $_______, and all other previous payments paid by the Owner to Contractor, the undersigned does hereby for and on behalf of Contractor, waive, release and relinquish Contractor's right to any claim or demand or right to impose a lien or liens for work done or materials or services furnished or any other class of lien whatsoever, on any of the property owned by the Owner on which improvements have been completed in connection with the Contract. |
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5. |
The Affiant represents that he/she has authority to execute a full and final release of lien for and on behalf of Contractor. |
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6. |
The Affiant makes this Final Affidavit and Release of Lien, pursuant to Chapter 713 of the Florida Statutes, for the express purpose of inducing the Owner to make final disbursement and payment to Contractor in the amount of $_________. |
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_______________________________
_________, Affiant |
STATE OF ______________)
) ss
COUNTY OF ____________)
The foregoing instrument was acknowledged before me this _______ day of ______________, 20_______ by _____________________, who is personally known to me or who has produced ______________ as identification.
______________________________________________
(Signature of Notary Public) |
______________________________________________
(Printed Notary Name) |
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