STATE OF GEORGIA
COUNTY OF ___________
Before me, the undersigned Notary Public, on this day personally appeared ("Deponent"), known to me to be the person whose name is subscribed below, and who, after being duly swore, deposes and states on oath that:
1. Deponent is the duly elected and presently acting (Office held) of (Name of Contractor) ("Contractor"), and, as such officer, is fully authorized to make this Affidavit, and has actual, personal knowledge of the matters set forth herein.
2. Contractor is acting as general contractor with respect to the construction of certain improvements (the "improvements") on certain property (the "Property) located in County, Georgia, which Property is described on Exhibit "A" attached hereto and made a part hereof, pursuant to a written contract with Name of Owner of Property ("Owner"), for the furnishing of labor, services, and/or materials in connection with the construction of improvements on the Property.
3. Pursuant to the Contract, the Contractor has caused the performance of work and the furnishing of labor, services, and materials in connection with the construction of Improvements on the Property, by, and only by, Contractor and those subcontractors, materialmen, and suppliers identified on Exhibit "B" attached hereto and made a part hereof.
4. Exhibit "B" attached hereto sets forth a complete list of all parties who, as of the date of this Affidavit, have supplied labor, services, and/or materials in connection with the construction of the Improvements on the Property.
5. As of the date of this Affidavit, all bills for labor, services, and materials used in the performance of the Contract or delivered to the Property at Contractor's instance have been paid and satisfied in full, except those bills set forth in Exhibit "C" attached hereto and made a part hereof.
6. All subcontractors, suppliers, materialman, and laborers who have furnished labor, services and/or material to the Property at Contractor's instance have been paid the agreed price or reasonable value of the labor, services, and/or materials furnished in the performance of the Contract.
7. The Contractor to the date hereof has fully performed the Contract in accordance with the terms thereof.
8. This Affidavit is made pursuant to the Official Code of Georgia Annotated Section 44-14-361.1, to induce the Owner to pay to Contractor the final disbursement of the contract price due under the Contract.
Dated this _____ day of May, 2009.
Sworn to and subscribed before me this
____ day of May, 2009.
My commission expires:
Sample Final Contractor's Affidavit
Personally appeared before me, the undersigned authority duly authorized and acting, Fredric J. Hutcheson, who being duly sworn deposes and states as follows:
1. That he is the _____, and that he is authorized to act solely on behalf of said company for the purposes hereof.
2. That ____ (hereinafter the "Contractor"), as general contractor for the construction of improvements to the property generally known as ______, has recently furnished materials and services and is now furnishing materials and services for the making of such improvements upon the property of ___ (hereinafter the "Owner") described as follows:
3. That the Contractor has been informed that the Owner is now selling the Property to ___, (the "Purchaser"), and that the Purchaser is executing a Deed to Secure Debt and Security Agreement to ___ (hereinafter the "Lender") upon the Property to secure a loan in the sum of $___.
4. Deponent says that the Contractor has been in direct charge of the construction of the improvements placed on the above property, and deponent states that said improvements have been constructed in accordance with the contract and are within the boundary line.
5. That in consideration of the sum of ___ Dollar ($___) in hand paid, and in order to enable the Purchaser to obtain said loan, the Contractor hereby subordinates in favor of the Lender any claim or lien which the Contractor may now have or hereinafter have against the Property for materials or services expended or used upon the same, and as to said Deed to Secure Debt and Security Agreement.
6. That the Contractor hereby certifies that Contractor is in charge of construction and that any services of architects, surveyors, laborers, materialmen, subcontractors, engineers or other persons or entities have been paid, and that no other person or entity is entitled to a claim of lien for labor or materials used or employed in the improvements or repairs of said property except __________ (If any work, materials or supplies provided within the last 95 days, attach a list of all such persons who provided the work along with a description of the type preformed as Exhibit "B.").
7. Deponent says further that the Contractor has been paid in full the agreed price or reasonable value of all labor, material, fixtures, suppliers, etc., used in making said improvements through ____ (date of closing), and that all contractors, suppliers, materialmen, and laborers have been paid in full the agreed price or reasonable value of all labor or supplies furnished or services rendered through ____ (date of closing).
8. Deponent further says that there are no unpaid bills of any nature, for labor, material, or services for any improvements made on said property, either in the construction or repair of any improvements thereon, and that there are no retention title contracts, bills of sale, or other encumbrances of record affecting title to any personal property installed on said premises. Deponent states that ___ hereby acknowledges receipt of payment in full for all amounts due and owing through ___ (date of closing) for making all of the improvements on said property aforementioned, and ____hereby waives, relinquishes, and releases any and all rights to any lien on said property for labor or material furnished through ____(date of closing).
9. Deponent further says that this sworn statement is made to the said owner in conformance with the provisions of O.C.G.A. § 44-14-361.2 (GCA § 67-2001.1) to induce ___, as purchaser, ___, as Lender, to purchase, make a loan on security of said property to the owner in the sum of $ _____, or make final disbursement, and further to induce Stewart Title Guaranty Company and ____ to issue its policy of title insurance insuring the title to the subject property.
WITNESS the hand and seal of the undersigned, this _____ day of FEBRUARY, 20__.
Sworn to and subscribed before
the undersigned witness and
notary public this _____ day of
FEBRUARY, 20__. ____________________________
No guidelines are available for this form at this time.