CONTRACTOR'S FINAL PAYMENT AFFIDAVIT
Florida Statute 713.06 (2003)
State of Florida
County of Pinellas
Before me, the undersigned authority, personally appeared
_______________________________________________________________________
who, after being first duly sworn, deposes and says of his or her personal knowledge the following:
1. He or she is the __________________________________ (title of affiant),
of _________________________________________ (name of contractor's business), which does
business in the State of Florida, hereinafter referred to as the "Contractor."
2. Contractor, pursuant to a contract with
__________________________________________ (name of owner), hereinafter referred to as the "Owner,"
has furnished or caused to be furnished labor, materials, and services for the construction of certain improvements to real
property as more particularly set forth in said contract.
3. This affidavit is executed by the Contractor in accordance with section 713.06 of the Florida
Statutes for the purposes of obtaining final payment from the Owner in the amount of $__________________.
4. All work to be performed under the contract has been fully completed, and all lienors under
the direct contract have been paid in full, except the following listed lienors:
NAME OF LIENOR AMOUNT DUE
_________________________________ ______________
_________________________________ ______________
Signed, sealed, and delivered this _____ day of _________, 2004.
______________________________ (contractor)
By: _________________________________
Title
Sworn to and subscribed before me this _______ day of __________ 2004, by ____________________________,
[ ] who is personally known to me OR [ ] who has produced _____________________________ as identification.
(S E A L) _____________________________________
Notary Public-State of Florida
Commission Number