CONTRACTOR'S INTERIM AFFIDAVIT STATE OF FLORIDA, COUNTY OF____________________. BEFORE ME, the undersigned authority, duly authorized to administer oaths and take acknowledgments, personally appeared _________________________ who being duly sworn, deposes and says: 1. He is the _________________________(title) of _________________________(name of business) hereinafter referred to as "Contractor." 2. At all times material hereto, Contractor has been doing business in _________________________ County, Florida. 3. This Affidavit is made pursuant to Section 713.06(3)(c)(1), Florida Statutes, for the purpose of acknowledging full payment to the Contractor for work done and materials supplied through ____________________, 20 ____, on real property described as: (property description) 4. That all lienors engaged by the Contractor to perform or provide labor, services and/or materials under the contract between Contractor and the owner of the above-described property have been paid in full for all work done or materials supplied through ____________________, 20 ____, except as follows: Name/Address _______________________________________________________ Amount Due _______________________ Name/Address _______________________________________________________ Amount Due _______________________ FURTHER AFFIANT SAYETH NOT. _______________________ (Signature of Contractor) Sworn to and subscribed before me by _________________________ who is personally known to me or produced _________________________ as identification, and who did ___ take an oath, this __________ day of ____________________, 20 ____. Signature of Notary _________________________ Printed Name of Notary _________________________ Commission No./Expiration _________________________ SEAL: