Fill and Sign the Limited Liability Company 497302024 Form

CONTRACTOR'S CERTIFICATION –CORPORATION or LLC (25 Del. C. §2707) COMES NOW, the undersigned affiant, as a representative of ____________________________________ , a ____________________ business entity and would state the following: 1. The above-mentioned company has provided labor or materials to the construction project at _________________________________________________________________ . 2. Said property is owned by __________________________________ , and is intended for use solely as a residence by said owner. 3. The undersigned has paid in full for all labor performed and materials furnished, and/or has provided a written release of mechanics’ lien signed by all parties who might be entitled to a lien against the above-mentioned property. This the _____ day of _________________ , 20 ______ . _________________________________ Name of Company By: __________________________ ______ _ _____ Signature Title ________________________________ Type or Print Name State of Delaware County of _____________________ ______________________________(Date) ______________________________ (Name(s) of person(s)) This instrument was acknowledged before me on _________________________ by __________________________________ as _________________________ (Type of authority, e.g., officer, trustee, etc.) of ________________________________________. (Name of party on behalf of whom instrument was executed). ________________________ (Signature of Notarial Officer) _____________________ Print Name ______________________ (Title and Rank) Contractor’s Certification Page 1 of 2 (Seal, if any) (My commission expires:____________________.) DE Tit. 25, § 2707 Contractor’s Certification Page 2 of 2