North Carolina Land Title Association AFFIDAVIT/AGREEMENT REGARDING LIENS To:__________________________________ (“Title Company”) STATE OF _________________ COUNTY OF _______________ On this ____ day of ______________________, 20____, before me personally appeared _______________________________, Owner of Property and __________________________________ ____________________, General Contractor, to me personally known, who, being duly sworn on their oaths, did say as follows: FOR CONSTRUCTION RECENTLY COMPLETED: (1) that, in the event that this affidavit is given for the purpose of obtaining title insurance on property on which recent improvements have been made and construction is completed, they are the Owner of the property hereafter described and the General Contractor in connection with the construction or repair of the improvements located on said property as indicated above (if the word “none” appears in the above space preceding “General Contractor,” Owner stated that said construction or repair was made under his own supervision, no general contractor having been employed) and that all of the persons, firms and corporations, except those names, if any, appear on the Waiver of Liens on the reverse side/following page hereof, including the General Contractor and all sub- contractors, who have furnished services, labor or materials, according to plans and specifications, or extra items, used in the construction or repair of such improvements, have been paid in full, that there are no mechanic's or materialmen's liens against said property and no claims outstanding which would entitle the holder thereof to claim a lien against the property (except those claims, if any, which are waived by the Waiver of Liens on the reverse side/following page(s) hereof) and that such construction or repair has been fully completed and accepted by the Owner. The General Contractor hereby waives and releases his right to file a mechanic's or materialmen's lien against said property; further, that there are no financial statements, chattel mortgages, conditional bills of sale or retention of title agreements affecting any fixtures or any cabinets, mantels, awnings, door, windows or screens therefore, or any plumbing, lighting, heating, cooling, refrigerating, ventilating or airconditiioning equipment or apparatus used separately or in combination as packaged units or installations in connection with the improvements on the property; OR ---------------------------- FOR NO RECENT IMPROVEMENTS: (2) that, in the event that this affidavit is given for the purpose of obtaining title insurance on property on which there have been no recent improvements, the Owner says on oath that there are no pending suits, judgments, executions, or encumbrances against Owner in the State of North Carolina or in any Federal Court; except: Owner swears that no improvements or repairs have been made on said property during the one hundred twenty (120) days immediately prece3ding this date; that there are not outstanding bills incurred for labor employed and materials used in making any repairs or improvements on said premises, and that there are no unpaid bills or liens against said property for sewage, street improvements, etc.: except: ---------------------------- The parties hereto, hereby request the Title Company to issue its policy or policies of title insurance upon said real estate without exception therein as to any possible unfiled mechanic’s or materialmen’s liens, and in consideration thereof, and as an inducement therefore, said affiants do hereby, jointly and severally agree to indemnify and hold said Title Company harmless of and from any and all loss, cost, damage and expenses of every kind, including attorney’s fees, which said Title Company shall or may suffer or incur or become liable for under its said policy or policies now to be issued, or any re-issue, renewal or extension thereof, or new policy at any time issued upon said real estate, part thereof or new policy at any time issued upon said real estate, part thereof or interest therein, arising , directly or indirectly out of or on account of any such mechanics’ or materialmen’s lien or liens or claim or claims or in connections with its enforcement of its rights under this agreement. The real estate and improvements referred to herein are situated in the County of ____________________________ , State of North Carolina, and are described as follows: ________________________________________________(SEAL) (Seller/Owner of Property) ________________________________________________(SEAL) (Seller/Owner of Property) ________________________________________________(SEAL) General Contractor WARNING NORTH CAROLINA GEN. STAT. 44A-24 MAKES IT A CRIMINAL OFFENSE TO SIGN THIS AFFIDAVIT IF THERE IS ANY SUM DUE OR CLAIMED TO BE DUE FOR LABOR OR MATERIAL Executed, subscribed, and sworn to and before me the ______ day of ___________, 20_____. ______________________________________ My Commission Expires:__________________________ Notary Public 1993 North Carolina Land Title Association North Carolina Land Title Association WAIVER OF LIENS We, the undersigned, are subcontractors, materialmen, or other person furnishing services or labor or materials, as indicated beside our respective signatures below, in the construction or repair of improvements upon the real estate briefly described on the reverse side/preceding page hereof. In consideration of the sum of $1.00 and other valuable consideration to each of us in hand paid, receipt whereof is hereby acknowledged, and other benefits accruing to us, in order to procure the conveyance of said real estate and the making of one or more loans on said real estate, as improved, we do hereby waive, release and quit-claim in favor of each and every party receiving title to said real estate through conveyance, their successors and assigns, from the owner named on the reverse side/preceding page(s) hereof, and every party making a loan on said real estate, as improved, and his or its successors and assigns, all right that we, or any of us, may now or hereafter have to a lien upon said laws; and we do further warrant that we have not and will not assign our claims for payment, nor our right to perfect a lien against said property, and that we have the right to executed this waiver and release thereof. ALL of the subscribers to this agreement respectively warrant that all laborers employed by them upon the aforesaid premises have been fully paid and that none of such laborers have any claim, demand, or lien against said premises; and further, that no financing statements, chattel mortgage, conditional bill of sale or retention of title agreement has been given or executed by the owner or any general contractor or other party or any of us, for or in connection with any material, appliances, machinery, fixtures, or furnishings placed upon or installed in the aforesaid premises by any of us, other than: ____________________________________________________________________ It is understood and agreed that any and all signatures hereto are for all services rendered, work done and material furnished heretofore and hereafter by the signers in any and all capacities, and are not understood to be only for the particular item against which the signature is affixed. Witness the following signatures and seals this ____ day of _________________, 20_______. ______________________________________ ____________________________________(SEAL) Labor or Material Furnished & By Whom ______________________________________ ____________________________________(SEAL) Labor or Material Furnished & By Whom ______________________________________ ____________________________________(SEAL) Labor or Material Furnished & By Whom ______________________________________ ____________________________________(SEAL) Labor or Material Furnished & By Whom ______________________________________ ____________________________________(SEAL) Labor or Material Furnished & By Whom ______________________________________ ____________________________________(SEAL) Labor or Material Furnished &By Whom 1993 North Carolina Land Title Association