Fill and Sign the Affidavit of Payment Prior to Sale Individual Form

Affidavit of Payment Prior to Sale Page 1 of 1 Affidavit of Payment Prior to Sale – Individual (Va. Code Ann. § 43-13.2) State of Virginia County (or city) of ___________________, to wit: I, ___________________________________ (notary or other officer) for the county (or city) aforesaid, do certify that, __________________________________ owner or ___________________________________ agent for owner of the property located at and described as _____________________________________________________________________________________________________________________________________________, this day made oath before me in my county (or city) aforesaid that: 1. The undersigned is both the owner of a one-or two-family residential dwelling unit, and either (a) a developer of such property, (b) a contractor in connection with the development or improvement of such property, or (c) a contractor or subcontractor furnishing labor or material in connection with the development or improvement of such property. 2. ( ) All persons performing labor or furnishing materials in connection with the improvements on such property and with whom the owner is in privity of contract have been paid in full, or ( ) The name, address and amount payable or claimed to be payable to any person so performing labor or furnishing materials and with whom such owner is in privity of contract is _______________________________________________________________________________________________________________________________________________. ____________________________________ Signature of Owner ____________________________________ Type or Print Name Given under my hand this the _____ day of ______________ 20_______. ________________________________ (Notary Public or Magistrate, et cetera.)