Fill and Sign the Contractors Final Payment Affidavit Individual Form

Contractor’s Final Payment Affidavit Page 1 of 3Prepared by, recording requested by and return to:Name: ___________________Company: ___________________Address: _____________________City: __________________________State: _____Zip: _____________Phone: _____________________Fax: _______________________----------------------Above this Line for Official Use Only--------------------- CONTRACTOR'S FINAL PAYMENT AFFIDAVIT – INDIVIDUAL STATE OF FLORIDACOUNTY OF ______________________.BEFORE ME, the undersigned authority, personally appeared ___________________________ (name of affiant) who, after being first duly sworn, deposes and says of his or her personal knowledge the following:1. He or she is the _________________________ (title of affiant) of ____________________________ (name of contractor’s business) which does business in the state of Florida, hereinafter referred to as the "Contractor."2. Contractor, pursuant to a contract with _________________________ (name of owner), hereinafter referred to as the "Owner," has furnished or caused to be furnished labor, materials, and services for the construction of certain improvements to real property as more particularly set forth in said contract.3. This Affidavit is executed by the Contractor in accordance with Section 713.06 of the Florida Statutes for the purposes of obtaining final payment from the Owner in the amount of $_______________. Contractor’s Final Payment Affidavit Page 2 of 34. All work to be performed under the contract has been fully completed, and all lienors under the direct contract have been paid in full, except the following listed lienors:Name/Address of Lienor _________________________________________________________Amount Due ____________________________Name/Address of Lienor ________________________________________________________Amount Due _____________________________Signed, sealed and delivered this _____ day of __________________, 20______. By: ___________________________ Name of Affiant ______________________Title of Affiant______________________Type or Print Name______________________Name of Contractor’s Business State of ______________ County of _____________ Sworn to (or affirmed) and subscribed before me this _____ day of _______________, 20____ by ______________________ (name of affiant) who is personally known to me or produced _________________________ as identification, and did take an oath.________________________________ NOTARY PUBLICPrinted Name of Notary _________________________My Commission Expires: _________________________ Contractor’s Final Payment Affidavit Page 3 of 3 Certificate of Service I, _____________________________________, hereby certify that I have delivered this day a true and attested copy of the foregoing to ___________________________________ by: ( ) Actual Delivery to the person to be served. ( )Mailing a true and correct copy of same by registered or certified U.S. mail, with postage prepaid, or by overnight or second-day delivery with evidence of delivery. ( ) If service cannot be made by the above methods, by posting on the premises. ________________________Signature