Fill and Sign the Texas Payment Form

DEMAND FOR AFFIDAVIT OF PAYMENT OF SUBCONTRACTORS, MATERIALMEN, ETC. BY SUBCONTRACTOR- CORPORATION The undersigned corporation, ________________________________ , hereby requests that ________________________________ , as a person who has furnished labor or materials for the construction of improvements on real property, provide to the undersigned or the undersigned’s agent an affidavit stating that the person has paid each of the person's subcontractors, laborers, or materialmen in full for all labor and materials provided to the person for the construction. In the event, however, that the person has not paid each of the person's subcontractors, laborers, or materialmen in full, the undersigned requests that the person state in the affidavit the amount owed and the name and, if known, the address and telephone number of each subcontractor, laborer, or materialman to whom the payment is owed. Signed on the _____ day of _______________ , 20 _____ . Signature       Printed Name _____ ________________________________ Title _____ _______________________________ Name of Corporation Certificate of Delivery I,       , hereby certify that I have delivered this day a true and correct copy of the foregoing to       by: Hand Delivery. Mailing a true and correct copy of same by Certified or Registered U.S. Mail, postage prepaid, to       , at his/her last known business or residence address located at       . So certified this the _____ day of _______________ , 20 _____ . Signature TX Code § 53.085(a) Demand for Affidavit of Payment of Subcontractor Page 1 of 1