Fill and Sign the Field 11 Form

- 1 - 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.
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