Partial Release Of Liens And Affidavit printable pdf download

Partial Release of Liens and Affidavit

Know all men by these presents:

That the undersigned, for and in consideration of the payment made by: Nichols Contracting, Inc. to

said undersigned for labor in and/or materials and equipment furnished for the construction of

(Project Name): _

including the payment of (amount of partial payment): ________________________________,

dated ___________, _____ does hereby acknowledge payment and to the entente of said payments does

herby release and discharge the above concern, Nichols Contracting, Inc. a Corporation and the surety

or sureties on each of their bonds for the progress to date and completion of said job, from any and all

demands, accounts and obligations we may have arising out of labor and/or materials and equipment

furnished the same at the request or order, directly or indirectly of said undersigned. The undersigned

does herby certify, and it is one of the expressed conditions upon which payment is made, that all

persons, firms or corporations who have supplied labor, and/or materials and equipment to the

undersigned and/or to the above mentioned job by order of said undersigned, either directly or indirectly,

have been paid therefore in full and that all payrolls and affidavits have been submitted in full. The

undersigned further certifies that all taxes, federal, state and local, and trust and welfare funds (if

applicable) have been paid in full.

By: ______________________________________________________, on oath says that he has

(print name and title)

read the foregoing affidavit by him subscribed and knows the contents thereof, that he is the person

authorized to make oath thereto; and that the statements therein are true.

Signature: __________________________________________, Date ____________________

NOTARY:

Subscribed and sworn to before me this _________day of _______________, 20_______

(Seal)

State of ___________________________, County of _____________________________

My Commission expires: __________________

__________________________________________

NOTARY PUBLIC

Partial Release Of Liens And Affidavit