Fill and Sign the Affidavit Full Form

AFFIDAVIT OF PAYMENT IN FULL - INDIVIDUAL (Ohio Revised Code Section 1311.011(B)(1)) State of Ohio County 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 1 of 2 Acknowledgment of Individual STATE OF OHIO COUNTY 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 Affidavit of Payment in Full – Individual Page 2 of 2