Sworn Statement Of Account With Copy Of Subcontract
ADVERTISEMENT
1SWORN STATEMENT OF ACCOUNT
WITH COPY OF SUBCONTRACT
State of Florida
County of _______________
Before
me,
the
undersigned
authority,
personally
appeared
_______________of______________(“Subcontractor”) who first being duly sworn on
oath, deposes and says with personal knowledge that:
1.
As the authorized agent for Subcontractor, he/she is furnishing the
following information in compliance with a written request made by the Owner, dated
____________________________.
2.
That pursuant to contract with _____________________(Contractor), a
copy of which is attached:
a.
that certain labor, materials, and services have been supplied, specifically
__________________________________________________________
for (property address)____________________________________.
b.
that certain labor, material and services are still to be supplied,
specifically,_________________________________________________
c.
that the original total contract amount is: $_____________
d.
that approved change orders total $_____________(copies of such
change orders are attached) for an amended total contract price of
$____________
e.
that the amount paid on account to date is: $
f.
that the amount presently due as of the date of this statement is:
$__________
g.
that the amount to become due after all labor, materials, and services to
be provided is $_____________
Dated this ____ day of _________________, 20__.
__________________________
Address:
Subcontractor name
__________________________
Phone:____________________
E-mail:____________________
Sworn to (or affirmed) and subscribed by me this ___ day of _______________,
20__,
by
Subcontractor
who
is
personally
known
to
me
or
produced
______________________________________ as identification, and did/did not take an
oath.
__________________________
Notary Public
My Commission Expires:
CERTIFIED MAIL RETURN RECEIPT NO.
Section
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal