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Contractor' s Request for Payment <br /> CERTIFICATION OF CONTRACTOR <br /> CERTIFY THAT ALL ITEMS AND AMOUNTS SHOWN ON THE FACE OF THIS ESTIMATE # <br /> ARE CORRECT ; THAT ALL WORK HAS BEEN PERFORMED AND/OR MATERIALS <br /> SUPPLIED IN FULL ACCORDANCE WITH THE TERMS AND CONDITIONS OF THIS <br /> CONTRACT BETWEEN <br /> OWNER AND <br /> , CONTRACTOR , DATED <br /> THIS AFFIDAVIT IS MADE PURSUANT TO SECTION 713 . 06 ( 3 ) ( c) ( 1 ) , FLORIDA STATUTES , <br /> FOR THE PURPOSE OF ACKNOWLEDGING FULL PAYMENT BY THE CONTRACTOR FOR <br /> WORK DONE AND MATERIALS SUPPLIED THROUGH 20_ 1 ON REAL <br /> PROPERTY DESCRIBED AS : ( PROPERTY DESCRIPTION ) <br /> THAT ALL LIENORS ENGAGED BY THE CONTRACTOR TO PERFORM OR PROVIDE LABOR , <br /> SERVICES AND/OR MATERIALS UNDER THE CONTRACT BETWEEN CONTRACTOR AND <br /> OWNER OF THE ABOVE - DESCRIBED PROPERTY HAVE BEEN PAID IN FULL FOR ALL <br /> WORK DONE OR MATERIALS SUPPLIED THROUGH , 20 <br /> EXCEPT AS POLLOWS : <br /> NAME ADDRESS AMOUNT DUE <br /> CONTRACTOR : <br /> BY : <br /> BY : ( Notary Public) <br /> TITLE : <br /> DATE : <br /> PR-2 <br />