CONTRACTOR'S FINAL PAYMENT AFFIDAVIT

STATE OF FLORIDA COUNTY OF _________________

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. 1. Your affiant is the _________________ of _________________, which does business in the State of Florida, hereinafter referred to as "CONTRACTOR".
   
   
2. 2. CONTRACTOR, pursuant to a contract with _________________, 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. 3. This affidavit is executed by the CONTRACTOR in accordance with Section 713.06 of the Florida Statutes for the purpose of obtaining final payment from the OWNER in the amount of $_______________.
   
   
4. 4. All work to be performed under the contract has been fully completed, and all lienors under the contract have been paid in full, except the following listed lienors:

NAME OF LIENOR________________________________________

AMOUNT DUE_____________

Signed, sealed and delivered this ___ day of __________, 200__.

SWORN TO AND SUBSCRIBED before me this _____ day of __________, 200__, by _______________, who is personally known to me _____ or did produce ____________ as identification, and who did ____ did not _____ take an oath.