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_ M M <br />COUN'!.'Y OF r>lq <br />personally before the undersigned officer, aufi <br />of said state to administer oaths, comes `z' e -H A e -m <br />who on oath says; <br />r� o- <br />CO <br />Ze�`byy� <br />That he is the Contractor with who Indian River County, Florida, a <br />political subdivision of said state, did on the day of ✓ Ns� , <br />12S , enter into a contract for the performance of certain work, more <br />particularly described as follows: <br />J f�fiG�J >`JG �--.TAT7 oral <br />Affiant further says that said construction has been completed and <br />the contract therefore fully performed and final payment is now due and <br />that all lienors contracting directly with or directly employed by such <br />contractor have been paid in full EXCEPT: <br />DESCRIPTION <br />t'Jotii �- <br />AMOUNT <br />who have not been paid and who are due the amount set forth.. <br />WITNESS: (Corporate Seal) <br />-a. <br />jpI _ tractor) <br />ryab� fh; end s<�`Orn, tr, before m� I <br />"'.'day of �" 1� Attest: <br />' <br />- <br />5, is S to of Flo a large <br />n4y i <br />S3. expires: <br />expires: „ <br />' s (Notary Seal) <br />t on above and hereby <br />I h2rc- ith acknowledge receipt of final paymen <br />certify that I have no claims against the own f said pr <br />(co tra r) <br />7 <br />L- JUN 131984 <br />FP -1 <br />Boa 57 PACE 398 <br />