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CUidTRACTUR'S AFFIDAVIT <br />and • <br />WAIVER OF LIEN <br />INVOICE N0. <br />STATE OF <br />COU~JTY OF <br />ss: <br />of <br />being. sworn, says that he is the <br />of <br />hereinafter referred to as the "Contractor") and is familiar with the facts <br />herein stated. <br />The Contractor has furnished all material, labor, tools, equipment, construction <br />facilities and everything of every sort and has performed all work required by <br />the contract entered into with dated the day <br />of 19 pertaining: <br />The Contractor has fully paid for all said material, labor, tools, equipment, <br />construction facilities, and everything of every sort furnished by it, or by its <br />subcontractors or materialmen, upon said premises and furnished therefor for said <br />work. <br />The balance remaining due from and unpaid to <br />Contractor, is the sum of and upon the <br />payment to Contractor of said sum, Contractor hereby waives all liens and claims <br />against its premises and property, and, <br />further, Contractor represents that no other person or party has any right to a <br />lien on account of any work performed for, or material furnished to Contractor <br />for said work. <br />Company <br />BY: <br />Title <br />Sworn to me and subscribed in my <br />presence this day of <br />19 <br />Notary Public <br />My Commission Expires: <br />