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OCT-05-2001 15:20
BINK PARTNERSHIP
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Contractor's Affidavit of
Release of Liens
AlA Document G706A .
Electronic Format
o 1- '58l.6 1"1.,0
OWNER
ARCHITECT
CONTRACTOR
SURETY
OTHER
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[x]
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TInS DOCUMENT HAS IMPORTANT LIlGAJ.. CONSEQUENCES; CONSULTATION wrm AN ATIORNEY IS ENCOURAGED wrm RESPIlCT TO ITS
COMPLETION OR. MODIFICATION. AUTHIlNTICA TION OF THIS ELECTRONlCALL Y DRAFTEI) AlA DOCUMENT /vIA Y BE MADE BY USING AlA
DOCUMENT 0401.
TO OWNER:
(Name and addr~$S)
Trinity U. M. Church
421 Bridge Street
New Cumberland, PA 17070
ARCHlTECT'SI'ROJECTNO.: 01021
CONTRACT FOR: Renovations to
405 Bridge Street
New Cumberland, PA
17070
PROJECT: Trinity U. M. Church
(li"",. tmd add,...) 405 Bridge Street
. New Cumberland, PA 17070
CONTRACT DATED: October9,2001
STATE OF: PA
COUNTY OF: New Cumberland
The undersigned. hereby certifies that to the best of the undmlligned's knowledge, information and belief, except as listed below, tilt
Releases or Waivers of Lien attacbed hereto include the Contractor, all Subcontractors, all suppliers of materials and equipment, and
all perfunncrs of Work, labor or seIVices who,.have or may have liens or encumbrances or the right to assert liens or encumbrances
against any property of the Owner arising in any manner outof the performance of the Contract referenced above:
EXCEPTIONS:
SUPPORTING DOCUMENTS ATTACHED HERETO:
CONTRACTOR:'
(Name and addTess)
F. P. Verbos, Inc.
P. O. Box 4126A
Harrisburg, PA 17111-0129
1. Contractor's Release or Waiver of Liens, conditional
upon receipt affinal payment
2. Separatc Releases or Waivers of Licns from
Subcontractors and material and equipment suppliers, to
the extent required by thc Owner, accompanied by a list
thereof.
BY:~v/ j1i/~
(Slgnatu~ o/autltQri.%I!tlrepresentative)
NOI8riaI Seal
~osalie K. ~aldwin, NollIIy Public
Clt,y of Hamsburg, Dauphin County
~? Commission Expires luly 27, 200S
Notary
(Printed name and title)
hzelJ jJ. tJ 6Li!><fS
AlA DOCUMENT G706A - CONTRACTOR'S AFFIDAVIT OF RIlLEASE OF LIENS . 1994 EDrhoN . AlA . COPYRIGHT 1994 - THE AMERICAN
INS'ITIUfE OF ARCHITECTS, 1735 NEW YORK. AVIlNlJE N.W., WASHINGTON D.C 20006.5~~.. WARNING; Unli...sed pbotocopying violates U.S.
copyright law5 and is subject to legal pro~eculiOl'l. This document was electronically produced with ~on of ~hc AIA and can be reproduced without violation
until the date of expiration as noted. below.
Electronic Fonnat G706A - 1994
User Document: G706A.CON - 10/512001. AlA license Number 100416, which expires on 12/712001 -Page #1
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