Fill and Sign the Contractors Verified Statement of Labor and Materials and Amount Due Mechanic Liens Corporation or Llc Illinois Form

CONTRACTOR'S AFFIDAVIT- CORPORATION STATE OF ILLINOIS COUNTY OF __________________ The undersigned, upon being duly sworn, states that the undersigned is __________________________ of _______________________________ who is the contractor for the _______________________________ work on the building located at ________________________________________________________ owned by __________________________________ . That the total amount of the contract including extras is $ ___________________ on which the undersigned has received payment of $ ____________________ prior to this payment. That the following are the names of all parties who have furnished material or labor, or both, for said work, and the amount due or to become due to each. Name Address Labor/Material Supplied Contract Amount Amount Paid Amount Payment Due Balance _____________ _____________ _____________ _____________ _____________________ ________ ________ _______ ______ _____________ _____________ _____________ _____________ _____________________ ________ ________ _______ _____ ____________ _____________ _____________ _____________ _____________________ ________ ________ _______ ______ _____________ _____________ _____________ _____________ _____________________ ________ ________ _______ ______ _____________ _____________ _____________ _____________ _____________________ ________ ________ _______ ______ _____________ _____________ _____________ _____________ _____________________ ________ ________ _______ ______ _____________ _____________ _____________ _____________ _____________________ ________ ________ _______ ______ Signed this ____ day of ___________________ , 20 _____ . __________________________________ Contractor _____ _____________________________ Type or Print Name Contractor’s Affidavit – Corporation Page 1 of 2 _____ _____________________________ Name of Corporation _____ __________________________________ Title State of _________________ County of_________________ Signed and sworn (or affirmed) to before me on ________________ (date) by ______________ (name/s of person/s making statement). _________________________________ Signature of Notary Public (SEAL) (770 ILCS 60/5) It shall be the duty of the contractor to give the owner, and the duty of the owner to require of the contractor, before the owner or his agent, architect, or superintendent shall pay or cause to be paid to the contractor or to his order any moneys or other consideration due or to become due to the contractor, or make or cause to be made to the contractor any advancement of any moneys or any other consideration, a statement in writing, under oath or verified by affidavit, of the names and addresses of all parties furnishing materials and labor and of the amounts due or to become due to each. Merchants and dealers in materials only shall not be required to make statements. Contractor’s Affidavit – Corporation Page 2 of 2