Fill and Sign the Florida Payment Construction Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: ___________________ Company: ___________________ Address: _____________________ City: __________________________ State: _____ Zip: _____________ Phone: _____________________ Fax: _______________________ JOINDER IN CERTIFICATE OF PAYMENT-INDIVIDUAL TO: Owner _________________________________ Owner's Address ____________________________________________________________ Lienor _________________________________ Lienor's Address ____________________________________________________________ Surety __________________________________ Surety's Address _____________________________________________________________ The undersigned joins in the Certificate of Payment to the Contractor recorded on _____ day of __________________ , 20 _____ , in Official Records Book ________ at Page ___________ , of the Public Records of _________________ County, Florida, and certifies that the facts stated in the Certificate of Payment to the Contractor are true and correct. DATED this _____ day of __________________ , 20 _____ . Signature _________________________ Printed Name _____ _ ________________ Address _____ ______________________ Joinder in Certificate of Payment Page 1 of 2 STATE OF _____________ COUNTY OF _____________ Sworn to (or affirmed) and subscribed before me this _____ day of _____________, 20_____ by _________________________ (name of person making statement). _________________________ NOTARY PUBLIC Print, Type or Stamp Commissioned Name of Notary Public _________________________ Commission Expires _________________________ Personally Known _________________ OR Produced Identification __________________ Type of Identification Produced _______________ A copy of this Joinder in Certificate of Payment has been served on the owner, surety and lienor at the addresses shown above on this __________ day of ________________, 20____. CLERK OF THE CIRCUIT COURT By: ____________________________ As Deputy Clerk (COURT SEAL) Joinder in Certificate of Payment Page 2 of 2