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2oioo�s�7 <br />ATTACHMENT 2 <br />CONTRA,CTOR'S SWQRN STATEMENT <br />State of <br />County of <br />The undersigned, being du]y sworn, an oath depases and says that he/she is the <br />(Title) of (Business Name), that he/she has a conCract with <br />, thc owner(s), to furnish labor and materials for the <br />(Description of Wark) on the follawing <br />described real estate in Caunty, State of NEbraska, commonly known as <br />(Street Address), and le�ally described as <br />(Legal Descriptipn). That, for the purppses of said contract, the fallawing persans, firms and <br />corporations have been contracted with, and have furnished or are fumishing and preparing material for, <br />and/or have done or are doing labor on the imprnvements to said real estate. That there is due and to <br />become due to them, respectively, the exact amounts sct apposite their names fnr material or labor as <br />stated. That this statement is a full, mae and complete staternent of all such persans, firms and <br />corporations, the amounts paid, and the ampunts due or ta become due to each. The undersigned further <br />states that all rnaterial (except any rnaterial disclosed herein) has bcen pr will 6e furnished from his/her <br />nwn stock and has been paid for in full, and that there are no other contracts for material ar labor <br />outstanding. The undersigned agrees tn furnish Waivers of Mechanic's Lien for all labor and materials <br />under the contract. <br />4846-G923-1367.3 D_� <br />