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201007863 <br />ATTACHMENT 2 <br />CONTRACTOR'S SWORN STATEMENT <br />State of <br />County of <br />'�'he undersigned, being duly swprn, on oath depases <br />(Title) of (Business <br />, the awner(s), to <br />described real estate in County, <br />(Stre�t <br />and says that helshe is the <br />Name), that hc/she has a contract with <br />furnish labor and materials for the <br />_(Descr�ption of Work) an thc following <br />5tate of Nabraska, commonly known as <br />Address), and legally dcscribed as <br />(Legad Descrrption). That, fo� the purposes of said cantract, the following persons, firms and <br />corporations have been contractcd with, and havc furnished or arc furnishing and preparin� matcrial for, <br />and/or have done or are doing labor on the improvements to said real estate. That there is due anc� to <br />become due to them, respec�ively, the exact amounts set oppositc their names for material or labor as <br />stated. That this statement is a full, true and complete statement o� a11 such persons, firms and <br />corporations, the amounts paid, and the amounts due or to become due to each. The undersigned further <br />states that all material (exccpt any material disclosed herein) laas been or will be furnished from his/her <br />own stock and has been paid for in full, and that there are no oCher contracts for material or labar <br />outstanding. The undersigncd agre�s ta furnish Waivers of Mechanic's Lien for ail labor and materials <br />under the contract. . <br />asas-z33z-tosa.z D-3 <br />