Transcription of SWORN STATEMENT FOR CONTRACTOR AND …
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SWORN STATEMENT FOR CONTRACTOR AND …
Escrow No.:Draw No.:1 Page:1 SWORN STATEMENT FOR CONTRACTOR AND SUBCONTRACTORTO OWNER AND TO CHICAGO TITLE INSURANCE COMPANYC ommitment No.:Escrow No.:Draw No.:1 State of Illinois County of CookTHE AFFIANT, Jay M. Bradarich Sr. being first duly SWORN , on oath deposes and says that he/she is President of LandmarkConstruction Systems, Inc., 18606 S. 81st Avenue, Tinley Park, IL 60487 that has contract with Applewood Property, LLC, ownerfor the following described premises in said County, to wit: 21020 Kostner Avenue, Matteson, IL 60443 That,forthepurposesofsaidcontract,thefol lowingpersonshavebeencontractedwith,andh avefurnished,orarefurnishingandpreparing materialsfor, ,respectively, ,trueandcompletestatementofallsuchperson s,theamounts paid and the amounts due or to become due to and AddressKind of WorkAmt of ContractRetention(inc.)
Escrow No.: Draw No.: 1 Page: 2 Name and Address Kind of Work Amt of Contract Retention (inc. Current) Net of Previous Payments Net Amount This Payment
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