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�. FINAL PAYMENT <br />CONTRACTOR <br />STATE OF FLORIDA <br />COUNTY OF <br />fa' Personally before me the undersigned officer, authorized by the laws of said state to <br />administer oaths, comes who on oath says: <br />I <br />That he is the Contractor with whom Indian River County, Florida, a political subdivision <br />of said state, did on the day of , 20_, enter into a contract for the <br />performance of certain work, more particularly describ�as follows: <br />PAVING AND DRAINAGE IMPROVEMENTS TO: <br />WILLOW STREET (I30m AVEN IBC PPHASE ROSE 11 BETNO.9 EN 85sr STREET & 89TH STREET <br />26 <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 <br />directly 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 />Contractor) <br />Subscribed and sworn to lar affirmed) before me on by <br />_(.idem,). 110A. N pot-0ly known <br />wmeorhaspmduccd es idensifimlian. <br />Man.,..) SEAL <br />(Na. ofNmary Typed, Primed or Stamped) <br />NOTARYPUBLIC (Commission M) <br />I herewith acknowledge receipt of final payment on above and do hereby certify, that I have no <br />claims against the owner of said property. <br />Contractor <br />FP -1 <br />