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Seller’s Affidavit of Payment of Subcontractor Page 1 of 3SELLER’S AFFIDAVIT OF PAYMENT OF SUBCONTRACTORS, MATERIALMEN, ETC. BY SUBCONTRACTOR - INDIVIDUAL STATE OF TEXASCOUNTY OF BEFORE ME, the undersigned authority, duly authorized to administer oaths and take acknowledgments, personally appeared who being duly sworn, deposes and says: 1.The undersigned is the seller of real property located at ____________________________________________________________________________ and identified below. This affidavit concerns the following project:Project Name or Address: Owner name and Address: Short Legal Description ("Real Property"): 2. This Affidavit is made for the purpose of acknowledging, and the undersigned states on oath, that the undersigned is the seller of the above-described real property and upon receipt of a request from ________________________________ the purchaser or the purchaser’s agent prior to closing of the purchase of the real property certifies that all contractors, laborers, or materialmen of the undersigned have been paid in full for all labor and materials provided to the undersigned seller through _____ day of _______________ , 20______ for construction of improvements on the real property and is not indebted to any person, firm or corporation by reason of any such construction through _____ day of _______________, 20______, except as follows (List unpaid persons):AddressPhone Name AddressPhone Name AddressPhone Name AddressPhone Name AddressPhone Name NameAddressPhone Seller’s Affidavit of Payment of Subcontractor Page 2 of 3 3. Optional: ____________ (initial if applicable) The affiant hereby waives or releases his or her lien rights upon receipt of actual payment or collection of funds when payment is made by check or draft.4.Optional: ____________ (initial if applicable) The affiant hereby warrants or certifies that the following bills or classes of bills will be paid by the affiant from funds paid in reliance on the affidavit: _____________________________________________________________________________.5. Optional: ____________ (initial if applicable) The affiant will indemnify the purchaser or the purchaser’s agent for any loss or expense resulting from false or incorrect information in the affidavit.NOTICE: A PERSON, INCLUDING A SELLER, COMMITS AN OFFENSE IF THE PERSON INTENTIONALLY, KNOWINGLY, OR RECKLESSLY MAKES A FALSE OR MISLEADING STATEMENT IN THIS AFFIDAVIT. SUCH AN OFFENSE IS A MISDEMEANOR. A PERSON ADJUDGED GUILTY OF SUCH AN OFFENSE SHALL BE PUNISHED BY A FINE NOT TO EXCEED $4,000 OR CONFINEMENT IN JAIL FOR A TERM NOT TO EXCEED ONE YEAR OR BOTH A FINE AND CONFINEMENT. A PERSON MAY NOT RECEIVE COMMUNITY SUPERVISION FOR THE OFFENSE. A PERSON SIGNING THIS AFFIDAVIT IS PERSONALLY LIABLE FOR ANY LOSS OR DAMAGE RESULTING FROM ANY FALSE OR INCORRECT INFORMATION IN THE AFFIDAVIT.FURTHER AFFIANT SAYETH NOT.Dated this the _____ day of _________________, 20____. Signature: Print Name: Doing Business as: SWORN TO AND SUBSCRIBED before me on this the _____ day of ______________, 20___ by . Notary Public Printed Name My Commission Expires: Seller’s Affidavit of Payment of Subcontractor Page 3 of 3TX Code § 53.085(b) and (c)