SOUTHERN TITLE INSURANCE CORPORATION

Owner’s and Contractor’s Affidavit and Release of Liens

(construction in progress - Form #127)

Case No. __________

commonwealth of virginia

CITY/COUNTY OF _______________

               The undersigned Owner of Property and __________________________________, General Contractor, under oath, say and certify that (1) they are the owner of the property hereafter described (the “property”) and the General Contractor in connection with the construction or repair of the improvements located on the property (if there is no “General Contractor”, owner states that said construction or repair was made under his own supervision, no General Contractor having been employed);  (2) all of the persons, firms and other entities, including the General Contractor and all subcontractors, who have furnished services, labor or materials, according to plans and specifications, or other extra items used in the construction or repair of such improvements have been paid for all labor or services performed and/or for all materials or supplies furnished up to the date hereof or, if not paid, that there are no late, past due or delinquent amounts or claims of amounts late, past due or delinquent as of said date;  (3) there are no mechanic’s or materialmen’s liens against the property.

                General Contractor hereby waives and releases it’s claim and right to file a mechanic’s or materialmen’s lien against the property.

                 The purpose of this affidavit is to induce (1) the construction lender to advance funds under a construction loan insured by SOUTHERN TITLE INSURANCE CORPORATION, hereafter referred to as the “Company” and (2) the Company to issue its policy of title insurance or an endorsement to the policy or future owner’s or loan policies (collectively referred to as the “policy”) without exception to claims of mechanics or materialmen in connection with an advance under a construction loan policy.

                The undersigned is aware that the Company relies upon the truth of the statements made in this Affidavit and the undersigned hereby jointly and severally indemnifies and holds the Company harmless of and from any and all loss, cost, damage, liability and expense of every kind, including attorney’s fees, which the Company shall or may suffer or incur or become liable for under its policy, directly or indirectly, as a result of any mechanic’s or materialmen’s lien or liens or claim or claims in connection with improvements, repairs or other construction on the property and in connection with the enforcement of  the rights of the Company under this Affidavit.

                The real estate and improvements referred to herein are situated in the City (County) of ___________________, Commonwealth of Virginia, and briefly described as _________________________________________.

_______________________________             Date _____________

Owner

_______________________________             Date _____________

Owner

_______________________________             Date _____________

General Contractor

COMMONWEALTH OF VIRGINIA

CITY/COUNTY OF __________________________

Executed, subscribed and sworn to before me this _________ day of ___________________________,

20 _______, by ______________________________

____________________________________________

Notary Public

My commission expires: ___________________