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Affidavit Of Contractor Form

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AFFIDAVIT OF CONTRACTOR

STATE OF OHIO

)

)SS:

COUNTY OF CUYAHOGA

)

__________________________, being duly sworn, says that he is the ____________________

of_____________________________________, the _____________________having a contract with

(the

“Owner”)

CMHA,

for

the

construction

___________________________________

_______________________, situated on or around or in front of the following described property:

_____________________________________________________________________________ whereof

____________CMHA_________________________ was the owner, part owner or lessee.

Affiant further says that the following shows the names of every subcontractor in the employ of said

_________________________ giving the amount, if any which is due, or to become due, to them, or any

of them, for work done on machinery, material or fuel furnished to date here of, under said contracts.

NOTE:

This statement must be accompanied by a similar sworn statement signed by each of the

subcontractors listed below.

SUBCONTRACTORS

Amount due or to become due for

work and material furnished to date

NAME

TRADE

Thereof

Said affiant further says that the following shows the names of every person furnishing machinery, material

or fuel to _____________________________ giving the amount, if any, which is due, or to become due, to

them or any of them, for machinery, material or fuel furnished to date hereof, under said contracts.

MATERIAL MEN

Amount Due or to Become Due for Work

NAME

TRADE

and Material Furnished to Date Hereof

Affidavit Of Contractor Form

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