FINAL AFFIDAVIT AND AGREEMENT
and
BUILDER/DEVELOPER STATUTORY PAYMENT AFFIDAVIT
(VIRGINIA CODE § 43-13.2)
STATE OF _______________________________,
COUNTY/CITY OF ________________________; TO-WIT:
On this ________ day of _____________________, 20___, before me personally appeared ________
___________________________________________________________________________________,
(a) Owner and developer of the property hereinafter described, the
(b) Owner and general contractor in connection with the development or improvements of the property hereinafter described, or the
(c) Owner and a contractor or subcontractor furnishing labor or material in connection with the development or improvement of the property hereinafter described;
to me personally known, who being duly worn on his/her oath, did say that all of the persons, firms and corporations, including the general contractor and all subcontractors who have furnished services, labor or materials according to plans and specifications, or extra items; used in the construction or repair of buildings and improvements on the real estate hereinafter described, have been paid in full and that such work has been fully completed and accepted by owner.
Affiant further says that no claims have been made to affiant by, nor is any suit pending against affiant by general contractor, contractor, subcontractor, laborer or materialmen, and further that no chattel mortgages, conditional bills of sale, retention of title agreements, security agreements, financing statements, or personal property leases have been given or are outstanding as to any fixtures, appliances, equipment which are now installed in or upon said real property or on the improvements thereon.
Affiant on behalf of said Owner of the Property and General Contractor does for a valuable consideration hereby agree and guarantee to hold Stewart Title Guaranty Company (by reason of the fact that it has issued or will issue in the future its title insurance policies), harmless against any lien, claim or suit of or by any general contractor, contractor, subcontractor, laborer or materialmen, and against any chattel mortgages, conditional bills of sale, retention of title agreements, security agreements, financing statements, or personal property leases in connection with the construction or repairs of such building or improvements on said real estate.
1. Property description:___________________________________________________________________
2. All persons performing labor or furnishing materials in connections with the improvements on said property and with whom the owner is in privity of contract have been paid in full unless noted below by name, address, and amount payable or amount claimed to be payable:
NAME AND ADDRESS AMOUNT PAYABLE
________________________________________________________ ___________________
________________________________________________________ ___________________
________________________________________________________ ___________________
________________________________________________________ ___________________
(attach additional sheets if necessary)
WITNESS the following signature:
By: ___________________________________________________
___________________________________________________
Print Name
The foregoing Final Affidavit and Agreement and Builder/Developer Statutory Payment Affidavit were subscribed and sworn to before me this ______ day of___________________, 20___, by __________________________________________________________________.
_________________________________________
Notary Public
My commission expires: ____________________.
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