Fill and Sign the Arkansas Liens Form

After Recording Return to: __________________________ __________________________ __________________________ __________________________ ) ) ) ) ) ) ) ) -------- Above This Line Reserved For Official Use Only---------------- AFFIDAVIT AGAINST LIENS ___________________________________ states on oath that he is the owner of the follow ing legally described lands in ____________________________________ County, Arkansas: ___________________________________ . Affiant states on oath that at no time after the _____ day of ___________ , 20 ______ , has any mechanic, builder, artisan, workman, laborer or other person, firm, or corporation done or performed any work upon said lands or any improvement thereon for which there has not been payment is full. Affiant also states on oath that at no time after the _____ day of _______________ , 20 ________ , has any person, firm or corpora tion furnished any materials, engine, boiler, machinery, equipment or parts for any building or improvement upon the lands above described or for repairing the same for which there is has not been payment in full. The only exceptions to this affidavit are the following: Name and Address Date Amount ___________________________________ ___________________________________ ___________________________________ ___________________________________ The undersigned specifically states that he has full and complete knowledge of the facts about which this affidavit is made, regardless of whether or not he was the owner or the occupant of said land during the period covered by this affidavit. Affidavit Against Liens Page 1 of 2 This affidavit is made with the intention that ___________________________________ shall rely upon its truth and with the expectation and intention that money shall be advanced by said ____________________________________ in reliance upon the truth of this affidavit. ___________________________________ Affiant S ignature _____ ______________________________ Print or Type Name STATE OF ARKANSAS COUNTY OF _________________ On this the ____ day of __________, 20__, before me, ____________________, the undersigned officer, personally appeared__________________________, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that he/she executed the same for the purposes therein contained. In witness whereof I hereunto set my hand and official seal on this ____ day of ______, 20___. ___________________________ NOTARY PUBLIC My Commission Expires: ____________________ Affidavit Against Liens Page 2 of 2