Fill and Sign the Ohio Property Lien Statutes Ohio Mechanics Lien Law Form

Affidavit of Corporation Page 1 of 3 AFFIDAVIT OF CORPORATION AS ORIGINAL CONTRACTOR REQUESTING RELEASE OF FUNDS BY LENDING INSTUTION (Ohio Revised Code Section 1311.011(B)(4)) State of OhioCounty of ___________________________________________________, whose address is ___________________________________________________________________________, being first duly sworn, states:1. Notice is hereby given that ___________________________________ as President of ________________________________, a _________________________________ corporation, whose address is ___________________________________________________________________, ___________________, Ohio _______________, [Contractor] has paid in full all subcontractors, material suppliers, and laborers, for all labor, work performed, and materials supplied prior to the date of purchase or during and prior to the payment period, excepting:(A)Claimant: ___________________________________Amount Claimed: __________________________________(B)Claimant: ____________________________________Amount Claimed: ___________________________________(C)Claimant: ___________________________________Amount Claimed: ___________________________________(D)Claimant: __________________________________Amount Claimed: _________________________________ Affidavit of Corporation Page 2 of 32. Further, that no other claims exist other than claims identified above. THIS the _____ day of _______________, 20______. By: ___________________________________ Type or Print Name: ___________________________________ Witness: __________________________________Witness: __________________________________ Attest: Secretary This instrument was prepared by __________________ (name).STATE OF OHIOCOUNTY OF _____________________ Affidavit of Corporation Page 3 of 3 The foregoing instrument was acknowledged before me this _____________________ (date) by __________________________________________ (name of officer or agent, title of officer or agent) of __________________________________________ (name of corporation acknowledging) a __________________________________________ (state or place of incorporation) corporation, on behalf of the corporation. ACKNOWLEDGED, SWORN TO AND SUBSCRIBED before me on this the _______ day of _____________________, _________. __________________________________ Notary Public My Commission Expires: _____________________This Instrument was prepared by: Signature Print or Type Name