Fill and Sign the 131106 Affidavit Time Period for Filing Contents Ohio Revised Code Form

Affidavit of Payment in Full – Individual Page 1 of 2 AFFIDAVIT OF PAYMENT IN FULL - INDIVIDUAL (Ohio Revised Code Section 1311.011(B)(1)) State of OhioCounty of _________________________________________________, whose address is _____________________________________________________________________________, being first duly sworn, states:1. Notice is hereby given that __________________________________ [Owner, Part Owner, or Lessee] has paid the original contractor, ________________________________, the amount of the home construction or home purchase contract price relating to the property at ____________________________________________________________________, in full, and further,2.That payment in full was made prior to receipt by affiant of receipt of a copy of any affidavit of mechanics’ lien pursuant to section 1311.07 of the Revised Code. THIS the _____ day of _______________ , 20______. By: ___________________________________Type or Print Name: ______________________ Witness: __________________________________Witness: __________________________________ Affidavit of Payment in Full – Individual Page 2 of 2 Acknowledgment of Individual STATE OF OHIOCOUNTY OF _____________________ The foregoing instrument was acknowledged before me this _____________________ (date) by _________________________________________ (name of person acknowledged.) ______________________________Notary Public Printed Name: _________________ My Commission Expires: _____________________ACKNOWLEDGED, SWORN TO AND SUBSCRIBED before me on this the _______ day of _____________________, _________. ____________________________________ Notary Public My Commission Expires: ________________ This Instrument was prepared by: Signature Print or Type Name