Fill and Sign the Sworn Statement Form

LIENOR'S REQUEST FOR SWORN STATEMENT FROM OWNER- CORPORATION WARNING: YOUR FAILURE TO FURNISH THE REQUESTED STATEMENT WITHIN 30 DAYS OR THE FURNISHING OF A FALSE STATEMENT WILL RESULT IN THE LOSS OF YOUR RIGHT TO RECOVER ATTORNEY FEES IN ANY ACTION TO ENFORCE THE CLAIM OF LIEN OF THE PERSON REQUESTING THIS STATEMENT. TO: ________________________________ ____________________________________ ____________________________________ (owner's name and address) Pursuant to Section 713.16(5), Florida Statutes, the undersigned hereby demands a written statement under oath from the owner showing the following concerning the improvement of real property identified as: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _____________________ . (insert description) 1. The contract amounts of all direct contracts. 2. The amount heretofore paid by or on behalf of the owner for all labor, services and materials furnished pursuant to the direct contracts. 3. The dates and amount paid or to be paid by or on behalf of the owner for all improvements described in any direct contracts. 4. The costs that you reasonably estimate will be required to complete the improvements according to the terms and specifications of any direct contract(s) under which construction has ceased. 5. If known, the actual cost of completion. ____________________________ (signature of corporate lienor) _____ ________________________ Type or Print Name _____ ________________________ Lienor’s Request for Sworn Statement Page 1 of 2 Title _____ _________________________ Name of Corporation _____ _______________________ _____ _______________________ (address of corporate lienor) _____ _______________________ (date of request) Lienor’s Request for Sworn Statement Page 2 of 2