HomeMy WebLinkAboutmisc letter CONTRACTOR'S FINAL AFFIDAVIT AND RELEASE OF LIEN
STATE OF Florida
COUNTY OF Saint Lucie ``''
BEFORE ME,the undersigned authority,personally Appeared E—M%, LoN ibtq ,who after being by
me first duly sworn,deposes and says of his personal knowledge that:
1- He is(AGENT or OWNER)of(COMPANY or PROPERTY)which(does business or is located)in the State of
Florida(hereinafter called the"Contractor"),
2- Contractor, ursurt to the Contract dated Z'IS-11- (hereinafter referred to as the"Contract")
with t cv& Lee l 1Za+k (hereinafter referred to as the"Owner'),has heretofore furnished or caused to
be furnished labor,materials and services for the construction of certain improvements as more particularly set
forth in the Contract.
3- Contractor represents that all work to be performed under the aforesaid Contract has been fully completed and
that all lienors under the direct contract have been paid in full except the following:
Name of Lienor: Amount Due:$0.00
4- In consideration of final payment of the Contractor in the amount of$ O.OQ and all other previous
payments paid by the Owner to the Contractor,the undersigned does hereby for and in behalf of the Contractor,
waive,release and relinquish the Contractor's right to any claim or demand or right to impose a lien or liens for
work done or materials or services furnished or any other class of lien whatsoever,on any of the property owned
by Owner on which improvements have been completed in connection with the aforementioned Contract.
5- The afftant represents that he has authority to execute a full and final release of lien-for and in behalf of the
Contractor.
6- The affiant makes this Affidavit and Release of lien,pursuant to Chapter 713,F o e x r rp se of
inducing the Owner to make final disbursement and payment to the Cont or in t nt .00
Contractor Signature(Agent)
(�vr.r t Las to IA
99 Printed Name Title)
State of t �J� EVV%L La�tOla CkSAovhiT,(
OMeS LRC
Company Name
County oC
I HEIZE13Y CERTIFY that on this day,before me,an Officer duly aut or'zed ip the State_aforesaid and the County
aforesaid to take acknowledgments,personally appeared C 1
to me known to be the person(s)described in or who has/have produced IQ VZL_ as identification and who
executed the foregoing instrument and he/she/they acknowledged before me that he/she/they,executed the same.
WITNESS my hand and official seal in the County and State last aforesaid this�Zt(7� day
of
t ry Signature
(Seal) Notary Pnnte Name
a1*RY P,aa', =AHOWEWE MY COMMISSION EXPIRES:
N of Florida260038Mv 30,2022