SW0801-CN110518 W1111
Final Bills Paid Affidavit
by Contractor
(hereinafter referred to as
BEFORE ME, the undersigned authority, personally appeared
"Contractor"), known to me to be a credible person, and after being by me duly sworn, upon oath stated and affirmed that:
"My name is go b t W and I am thegfRegf/ i poot/eri Af 3 Aolg/o GDA//Z rf L LC .
hereafter sometimes referred to in thi The undersigned Contractor has personal knowledge of the facts stated herein and
has full authority to make the agreements in this affidavit on behalf of Contractor.
Contractor, and
Pursuant to and in accordance with a written construction contract betweenjQP� /�fjid�D epeJ�
.� i / , O w ner /Administrator Contractor furnished materials and labor for the construction, renoion, , o or repaU of improvements located on or relating to proje� known as �f. 1VTa� � // � i o r repair S 065.4) "`l oc'ated
County, Texas, legally
at DF.c%a1 j /0 , City of ��i/k , 7k. described in Exhibit "A" attached hereto and made a part hereof for all purposes (the "Property"). All work provided
for under said written construction contract, together with all changes and supplements thereto, has been fully
completed in accordance with the terms and provisions thereof.
Contractor has paid each of its subcontractors, laborers, suppliers and materialmen in full for all labor and materials
provided to Contractor for or in connection with the construction, renovation, or repair of improvements on or relating to
the subject Property, or any portion thereof, excepting only the amounts owed for the following specified bills to the
persons identified below. Contractor warrants and represents that the following specified bills will be paid to Contractor
by Owner /Administrator in reliance on this Final Bills Paid Affidavit:
Name of Payee Address Telephone No. Amount Owed
N/74
Other than the above specified bills owed to the above referenced persons, Contractor is not aware of any unpaid bills,
claims, demands, or causes of action by any of its subcontractors, laborers, suppliers, or materiahen for or in connection
with the furnishing of labor or materials, or both, for the construction, renovation, or repair of improvements located on or
related to the subject Property.
In consideration of the funds paid to Contractor by Owner /Administrator and by Lender on behalf of Owner /Administrator
in reliance on this affidavit, Contractor waives and releases all of Contractor's statutory and constitutional mechanic's lien
rights connected with the construction of the Project, conditioned on the actual payment or collection if payment is made
by check or draft.
Contractor further understand that this Final Bills Paid Affidavit is being given pursuant to and in accordance with
Sections 53.085 and 53.259 of the Texas Property Code and that the intentional, knowing, or reckless making of a false or
misleading statement in this Affidavit constitutes an offense under said Section and is a Class A misdemeanor.
Contractor hereby indemnifies and holds harmless Owner /Administrator from any and all claims, demands or causes of
action, and any costs, expenses, and attorney's fees incurred in connection therewith, arising from or connected with, the
statements and representations contained herein."
Page 1 of 3
Form 16 — Final Bills Paid Affidavit May 1, 2009