KNOWN ALL MEN BY THESE PRESENTS:
BEFORE ME, the undersigned authority personally appeared ________________________ [NAME], the ____________ [TITLE] OF ______________________________[COMPANY] (hereinafter referred to as “Affiant”), and after being by me duly sworn, upon oath stated and affirmed that:
WHEREAS, Affiant furnished labor, services and/or materials for the construction of improvements for the benefit of ________________________________________ its successors and assigns [the “Owner”} at the following location: _________________________________________________, as more particularly described on Exhibit “A” attached hereto and made a part hereof for all purposes (the “Property”); and
For and in consideration of payment and receipt of $_______________, said sum being the total aggregate of sums of consideration, including, but not limited to all statutory and contractual retainage, being due to Affiant as payment for labor, services, and/or materials furnished to or for the construction of the aforementioned improvements, Affiant has and does hereby waive, relinquish and release its liens, claims, right and charges of every nature whatsoever which have arisen by virtue of any such labor service and/or material having been performed and/or furnished by Affiant, including any and all mechanic’s or materialman’s lien or liens claims afforded Affiant under the laws of the State of Tennessee. Affiant further agrees that, as of the date thereof, Affiant has paid or has caused to be paid all bills, invoices, charges or other amounts due and payable which are payable by Affiant to others for aforementioned improvements, together with all applicable local, state or federal taxes or assessments payable by Affiant for consideration of the aforementioned improvements , together with all applicable local, state or federal taxes or assessments payable by Affiant, and that Affiant agrees that it shall defend, indemnify, and hold harmless Owner, any title company certifying the condition of title with respect to the Property, and the Property itself from and against all claims alleging that amounts remain due with respect to any labor, service and/or materials provided by, for or under Affiant with respect to the aforementioned improvements (including court costs and reasonable attorney’s fees).
Executed this ____ day of _______________________, 2012.
Subscribed and sworn to before me, the undersigned authority, this ____ day of _______________, 2012.
My commission expires: ______________________
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