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• <br />40 <br />4W <br />40 <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 <br />administer oaths, comes who on oath says: <br />That lie is the Contractor with whom Indian River County, Florida, a political subdivision of <br />said state, did on the _day of .� 1999, enter into a contract for the <br />t <br />performance of certain work, more particularly described as follows: <br />WABASSO CAUSEWAY PARK IMPROVEMENTS <br />f <br />County Project # 9623B <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 />i <br />employed by such contractor have been paid in full EXCEPT: <br />Name Description ACnoun <br />I <br />I <br />who have not been paid and who are due the amount set forth. <br />i <br />WITNESS: (Corporate Seal) <br />- ' <br />I <br />(Contractor) <br />By: <br />Subscribed and sworn to before me this _ day of 2090. <br />L. <br />I <br />Attest: <br />r. <br />Notary Public <br />r <br />State of Florida at Large <br />My Commission expires: (Notary seal) <br />Name of Notary typed or printed <br />I herewith acknowledge receipt of Final Payment on above and do hereby certify that I have <br />no claims against the owner of said property. <br />Contractor <br />1'1NA1. PAY N1ENT <br />h <br />FP 1 <br />