SOUTHERN TITLE INSURANCE CORPORATION

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

(FINAL - COMPLETED IMPROVEMENTS - FINANCE/SALE)

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, except as set forth below: (NONE, unless specifically indicated below)

Claimant                                                                            Amount Due

______________________________         ______________________

______________________________         ______________________

______________________________         ______________________

 (3) there are no mechanic’s or materialmen’s liens against the property, except as indicated above, if any.

                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 full and final advance of funds under a construction loan or permanent loan insured by Southern Title Insurance Corporation, and  (2) Southern Title Insurance Corporation 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 and providing insurance against claims of mechanics and materialmen in the policy, and (3) the purchase of the property in the event the property is being sold.

                The undersigned is aware that Southern Title Insurance Corporation relies upon the truth of the statements made in this Affidavit and the undersigned hereby jointly and severally indemnifies and holds Southern Title Insurance Corporation harmless of and from any and all loss, cost, damage, liability and expense of every kind, including attorney’s fees, which Southern Title Insurance Corporation 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 Southern Title Insurance Corporation 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: _____________  STIC FORM #128