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4D <br />11 <br />May 25, 1999 <br />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 administer <br />oaths, comes <br />, who on oath says: <br />That he is the Contractor with whom Indian River County, Florida, a political subdivision of <br />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 />Il FROVEMENTS TO: <br />DONALD MACDONALD PARK <br />IRC PROJECT NO. 9625A <br />Affiant further says that said construction has been completed and the contract therefore fully <br />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 />Subscribed and swam to (or affirmed) before me on <br />to me or has produced <br />(Contractor) <br />By; <br />as identification. <br />by <br />s... <br />,...aur <br />(Signature) SHAL <br />NOTARY PUBLIC — (blame of Notary Typed, Printed or Stamped) <br />(Commission N) <br />I herewith acknowledge receipt of final payment on above and do hereby certify that I have no claims <br />against the owner of said property. <br />Contractor <br />FP -1 <br />