CONTRACTOR'S FINAL PAYMENT AFFIDAVIT AND CONDITIONAL

CONTRACTOR’S FINAL PAYMENT AFFIDAVIT AND

CONDITIONAL WAIVER AND RELEASE OF LIEN ON FINAL PAYMENT

STATE OF FLORIDA

COUNTY OF ____________________________

The undersigned, after being first duly cautioned and sworn, deposes and states of his or her own personal knowledge

that ________________________________________ (“Contractor”) has, pursuant to a contract with

________________________________________ (“Owner”), furnished or caused to be furnished labor, materials, and

services for the construction of certain improvements to the following described real property:

Situated in the County of _______________, State of Florida, and being further described as [Insert legal

description of property below]:

Being located at and more commonly known as ____________________.

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 $______________.

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:

NONE

The undersigned lienor, upon payment of a check received from Owner or Owner’s agent in the sum of $_____________,

has been paid in full and waives and releases its lien and right to claim a lien for all such labor, services, or materials

furnished to the above described property.

Signed this _____________ day of ______________________________, 20_______.

Signature:

Printed Name & Title:

Name of Contractor’s Business:

SWORN TO AND SUBSCRIBED before me by means of [ ] physical presence or [ ] online notarization, this

______day of _____________, 20__, by ______________________________, who is personally known to me; or

produced __________________ as identification, and did take an oath.

AFFIX NOTARY SEAL

Notary Public

Print Name:

My Commission Expires: