Fill and Sign the Bills Affidavit Form

FINAL BILLS PAID AFFIDAVIT Before me, the undersigned authority, personally appeared       (“Contractor”), known to me to e a credible person, and after being by me duly sworn, upon oath stated and affirmed that: “My name is       and I am the       [title] of       , hereafter sometimes referred to in this affidavit as “Contractor.” Contractor’s business address is       . The undersigned Contractor has personal knowledge of the facts stated herein and has full authority to make the agreements in this affidavit on behalf of Contractor. Pursuant to and in accordance with a written construction contract between       , Contractor, and       , Owner/Administrator, Contractor furnished materials and labor for the construction, renovation, or repair of improvements located on or relating to project known as       located at       , City of       ,       County, Texas, legally described in Exhibit “A” attached hereto and made part of this Affidavit for all purposes (the “Property”). All work provided for under said written construction contract, together with all changes and supplements thereto, has been fully completed in accordance with the terms and provisions thereof. Contractor has paid each of its subcontractors, laborers, suppliers, and materialmen in full for all labor and materials provided to Contractor for or in connection with the construction, renovation, or repair of improvements on or relating to the subject Property, or any portion thereof, excepting only the amounts owed for the following specified bills to the persons identified below. Contractor warrants and represents that the following specified bills will be paid to Contractor by Owner/Administrator in reliance on this Final Bills Paid Affidavit: PAYEE ADDRESS PHONE NO. AMOUNT OWED 1 2 3 4 5 6 Other than the above specified bills owed to the above referenced persons, Contractor is not aware of any unpaid bills, claims, demands, or causes of action by any of its subcontractors, laborers, suppliers, or materialmen for or in connection with the furnishing of labor or materials, or both, for the construction, renovation, or repair of improvements located on or related to the subject Property. In consideration of the funds paid to Contractor by Owner/Administrator and/or by Lender on behalf of Owner/Administrator in reliance on this affidavit, Contractor waives and releases all of Contractor’s statutory and constitutional mechanic’s lien rights connected with the construction of the Project, conditioned on the actual payment or collection if payment is made by check or draft. Contractor further understands that this Final Bills Paid Affidavit is being given pursuant to and in accordance with Section 53.085 and 53.259 of the Texas Property Code and that the intentional, knowing, - 1 - or reckless making of a false or misleading statement in this Affidavit constitutes an offense under said Section and is a Class A misdemeanor. Contractor hereby indemnifies and holds harmless Owner/Administrator from any and all claims, demands, or causes of action and any costs, expenses, and attorney’s fees incurred in connection therewith, arising from or connected with the statements and representations contained herein. EXECUTED this       day of       , 20       .       [Name of Contractor Company] By:       Printed Name:       Title:       Notary’s Acknowledgement Before me, the undersigned authority, on this day personally appeared       , who first being duly sworn by me to be the rperson whose name is subscribed to the foregoing Final Bills Paid Affidavit, acknowledged that he/she has the authority to make this Final Bills Paid Affidavit, and further acknowledged to me that he/she executed the same for the purpose and consideration therein expressed. GIVEN UNDER MY HAND AND SEAL OF OFFICE on this       day of       , 20       . (Seal)       Notary Public, State of Texas My commission expires       - 2 - EXHIBIT “A” - 3 -