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Dated <br />STATE OF <br />COUNTY OF <br />By: <br />(CONTRACTOR — must be signed by <br />an Officer of the Corporation) <br />Print Name and Title <br />Sworn to (or affirmed) and subscribed before me by means of ❑ physical presence or ❑ online <br />notarization, this day of 20 , by <br />(name of person making statement). <br />(Signature of Notary Public - State of Florida) <br />(Print, Type, or Stamp Commissioned Name of Notary Public) <br />❑ who is personally known to me or ❑ who has produced <br />as identification. <br />[The remainder of this page was left blank intentionally] <br />Contractor's Application for Partial Payment - 2 <br />