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r <br />I <br />r-_ STATE OF <br />I <br />AFFIDAVIT <br />Before me personally appeared the undersigned who, by me bong first duly sworn, deposes and says: <br />I 'Me undersigned is a sub -contractor under the prime contractor Ruder a contract entered into by and <br />between Indian River County, Florida and <br />for file pa formmae afthe following described work: <br />The undersigned fuller deposes and says that said labm, materials, and/or services were ofa total value of <br />S ,ofwhich there remains due owing and unpaid the sum of$ , to the undersigned. <br />(Cm,maw Seel) <br />(Sub-Contracmr) <br />MUNeR[g <br />ARE= <br />SubsmMi sM swan. W.M Na)berwe <br />Timbe is Oersonrlly k.— is me or <br />Mame orNoury TIM. Msmd or&M,M) <br />NOTARY PUBLIC <br />AF1 <br />SEAL <br />