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Contractor's Request for Payment <br /> CERTIFICATION OF CONTRACTOR <br /> I 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�, ON REAL <br /> PROPERTY DESCRIBED AS : ( PROPERTY DESCRIPTION) <br /> 1 <br /> i <br /> i <br /> I <br /> I <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 /> I WORK DONE OR MATERIALS SUPPLIED THROUGH 120_1 <br /> EXCEPT AS FOLLOWS : <br /> NAME ADDRESS AMOUNT DUE <br /> CONTRACTOR : <br /> BY: <br /> i <br /> BY: ( Notary Public) <br /> TITLE : <br /> DATE : <br /> i <br /> PR-2 <br />