11.07.2015 Views

Design & Construction Specifications - Town of Kernersville

Design & Construction Specifications - Town of Kernersville

Design & Construction Specifications - Town of Kernersville

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PROOF OF PAYMENTDOCUMENTTHIS IS TO CERTIFY that________________________________________________furnished the labor and materials for the construction <strong>of</strong>____________________________________________________________________________________________________________________ in the development knownas _______________________________________________, located in <strong>Kernersville</strong>,NC.That the total cost <strong>of</strong> construction <strong>of</strong>___________________________________________________________________________________________ was$__________________.That _______________________________________________________________has been paid in full by ___________________________________________________for these improvements and all contractors and subcontractors have been paid in full.This __________ day <strong>of</strong> ___________________, _______.______________________________________Company NameBy:___________________________________Title:__________________________________Sworn and subscribed before methis __________ day <strong>of</strong> ____________________, ________._______________________________________Notary PublicMy commission expires:____________________REPRODUCIBLE FORM

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