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FINAL PAYMENT <br />CONTRACTOR <br />STATE OF FLORIDA <br />COUNTY OF <br />Personally before me the undersigned officer, authorized by the laws of said state to <br />administer oaths, comes , who on oath says: <br />That he is the Contractor with whom Indian River County, Florida, a political subdivision <br />of said state, did on the _day of , 19_, enter into a contract for the <br />performance of certain work, more particularly described as follows: <br />WABASSO CAUSEWAY DARK <br />BEAUTIFICATION PROJECT <br />County Project No. 9623 <br />Affiant further says that said construction has been completed and the contract therefore <br />fully performed and final payment is now due and that all liens contracting directly with or directly <br />employed by such contractor have been paid in full EXCEPT: <br />Name Description Amount <br />who have not been paid and who are due the amount set forth. <br />WITNESS: (Corporate Seal) <br />By: <br />Subscribed and sworn to before me this <br />Attest: <br />Notary Public <br />State of Florida at Large <br />My Commission expires: <br />(Contractor) <br />Day of —, 19— <br />(Notar <br />19— <br />(Notary seal) <br />Name of Notary typed or printed <br />I herewith acknowiedge receipt of Final Payment on above and do hereby certify that I <br />have no claims against the owner of said property. <br />Contractor <br />F'INAI. ,PAYMENT <br />