“A legacy of quality with a future you can trust.”

Please contact Sue Schofield at 815.281.1129 or [email protected] or our Galena office at 815.777.3318 for any questions.

Click on the +/- to choose one of the forms to fill out below

Construction - Owner Statement

*REQUIRED

Sworn Statement for Owner

To Owner and Chicago Title Insurance Company

State of *

County of *

File *

Draw *

The Affiant, (name), on oath deposes and says that he is (position) owner of following described premises in (county), Illinois to: *

That, for purpose of said contract, the following persons have been contracted with, and have furnised, or are furnishing and preparing materials for, and have done or are doing labor of said improvement. That here is due and to become due to them, respectively, the amounts set opposite their names for materials or labor as stated. That this statment is a full, true and complete statment of all such persons, the amounts paid and the amounts due or to become due to each.

Name *

Address *

Kind of Work *

Amount of Contract *

(Credit) Extras *

Net of Prev. Payments *

Net Amt This Payment *

Balance to Become Due *

Name

Address

Kind of Work

Amount of Contract

(Credit) Extras *

Net. of Prev. Payments

Net. Amt This Payment

Balance to Become Due

Amount of Original Contract *

Extras to Contract *

Total Contract & Extras *

Credits to Contract *

Adjusted Total Contract *

Work Completed to Date *

Net Previously Paid *

Net Amount of this Payment *

Net Amount Extra / Credit *

Balance to Become Due *

It is understood that the total amount paid to date plus the amount requested in this application shall not exceed (%) of the cost of work completed to date. I agree to furnish Waivers of Lien for all materials under my contract when demanded.

Signature *

Position *

Subscribed and sworn to before me this (day) of (year).

This above sworn statement should be obtained by the owner before each and every payment.

Name

Contractor Statement

Final Lien Waiver

*REQUIRED

State of *

County of *

File *

Whereas the undersigned has been employed by (employer) to furnish (entry) for the premises known as (address) of which (name) is the owner. *

The undersigned, for and in consideration (entry) and (entry) /100 dollars ($) and other good and valuable considerations, the receipt whereof is hereby acknowledged, do(es) hereby waive and release any of all lien or claim of, or right to, lien, under the statutes of the state of Illinois, relating to mechanics' lien, with respect to and on said above-described premises, and the improvements thereon, and on the material, fixtures, apparatus or machinery furnished, and on the moneys, funds or other considerations due or to become due from the owner, on account of labor services, material, fixtures, apparatus or machinery heretofore furnished, or which may be furnished at any time hereafter, by the undersigned for the above-described premises. *

That there are no other contracts for said work outstanding, and that there is nothing due or to become due to any person for material, labor or other work of any kind done or to be done upon or in connection with said work other than above stated.

That, for purpose of said contract, the following persons have been contracted with, and have furnished, or are furnishing and preparing materials for, and have done or are doing labor of said improvement. That here is due and to become due to them, respectively, the amounts set opposite their names for materials or labor as stated. That this statement is a full, true and complete statement of all such persons, the amounts paid and the amounts due or to become due to each.

Dated *

Company Name *

Type Name and Title *

If you have contracted for labor or materials on this job you must complete the Contractor’s Affidavit.

Contractor’s Affidavit

State of *

County of *

To whom it may concern: The undersigned, being duly sworn, deposes and says that he is subtractor/supplier of the subcontractor/general contractor who is the contractor for the (entry) work on the building located at (address) owned by (owner). That the total amount of the contract including extras is ($). On which he has received a payment of ($) prior to this payment. That all waivers are true, correct and genuine and delivered unconditionally and that there is no claim either legal or equitable to defeat the validity of said waivers. That the following are the names of all parties who have furnished material or labor, or both, for said work and all parties having contracts or sub contracts for specific portions of said work or for materials entering into the construction thereof and the amount due or to become due to each, and that the items mentioned include all labor and material required to complete said work according to plans and specifications: *

Names

What for

Contract price including extras *

Amount Paid

This Payment

Balance Due

Names

What for

Contract price including extras*

Amount paid

This Payment

Balance Due

Date *

Signature *

Subscribed and sworn to before me this (date). *

Notary Public

*Extras include but are not limited to change orders, both oral and written, to the contract

The names and addresses of all principal suppliers should be listed even if all materials are from fully paid stock and delivered to the site by the subcontractor

Final Supply Lien Waiver

*REQUIRED

State of *

County of *

File *

Whereas the undersigned has been employed by (employer) to furnish (entry) for the premises known as (address) of which (name) is the owner. *

The undersigned, for and in consideration (entry) and (entry) /100 dollars ($) and other good and valuable considerations, the receipt whereof is hereby acknowledged, do(es) hereby waive and release any and all lien or claim of, or right to, lien, under the statutes of the state of Illinois, relating to mechanics' lien, with respect to and on said above-described premises, and the improvements thereon, and on the material, fixtures, apparatus or machinery furnished, and on the moneys, funds or other considerations due or to become due from the owner, on account of labor services, material, fixtures, apparatus or machinery furnished, or which may be furnished at any time hereafter, by the undersigned for the above-described premises. *

Dated *

Company Name *

Type Name and Title *

Signature *

Subscribed and sworn to before me this (date). *

Notary Public

Message

Partial Lien Waiver

*REQUIRED

State of *

County of *

File *

Whereas the undersigned has been employed by (employer) to furnish (entry) for the premises known as (address) of which (name) is the owner. *

Dated *

Company Name *

Type Name and Title *

If you have contracted for labor or materials on this job you must complete the Contractor’s Affidavit.

Contractor’s Affidavit

State of *

County of *

Names

What for

Contract price including extras *

Amount Paid

This Payment

Balance Due

Names

What for

Contract price including extras*

Amount paid

This Payment

Balance Due

Date *

Signature *

Subscribed and sworn to before me this (date). *

Notary Public

*Extras include but are not limited to change orders, both oral and written, to the contract

The names and addresses of all principal suppliers should be listed even if all materials are from fully paid stock and delivered to the site by the subcontractor

Please contact Sue Schofield at 815.281.1129 or [email protected] or our Galena office at 815.777.3318 for any questions.

Click on the +/- to choose one of the forms to fill out below

Construction - Owner Statement

*REQUIRED

Sworn Statement for Owner

To Owner and Chicago Title Insurance Company

State of *

County of *

File *

Draw *

The Affiant, (name), on oath deposes and says that he is (position) owner of following described premises in (county), Illinois to: *

Name *

Address *

Kind of Work *

Amount of Contract *

(Credit) Extras *

Net of Prev. Payments *

Net Amt This Payment *

Balance to Become Due *

Name

Address

Kind of Work

Amount of Contract

(Credit) Extras *

Net. of Prev. Payments

Net. Amt This Payment

Balance to Become Due

Amount of Original Contract *

Extras to Contract *

Total Contract & Extras *

Credits to Contract *

Adjusted Total Contract *

Work Completed to Date *

Net Previously Paid *

Net Amount of this Payment *

Net Amount Extra / Credit *

Balance to Become Due *

Signature *

Position *

Subscribed and sworn to before me this (day) of (year).

This above sworn statement should be obtained by the owner before each and every payment.

Comment

Contractor Statement

Final Lien Waiver

*REQUIRED

State of *

County of *

File *

Whereas the undersigned has been employed by (employer) to furnish (entry) for the premises known as (address) of which (name) is the owner. *

Dated *

Company Name *

Type Name and Title *

If you have contracted for labor or materials on this job you must complete the Contractor’s Affidavit.

Contractor’s Affidavit

State of *

County of *

Names

What for

Contract price including extras *

Amount Paid

This Payment

Balance Due

Names

What for

Contract price including extras*

Amount paid

This Payment

Balance Due

Date *

Signature *

Subscribed and sworn to before me this (date). *

Notary Public

*Extras include but are not limited to change orders, both oral and written, to the contract

The names and addresses of all principal suppliers should be listed even if all materials are from fully paid stock and delivered to the site by the subcontractor

Message

Final Supply Lien Waiver

*REQUIRED

State of *

County of *

File *

Whereas the undersigned has been employed by (employer) to furnish (entry) for the premises known as (address) of which (name) is the owner. *

The undersigned, for and in consideration (entry) and (entry) /100 dollars ($) and other good and valuable considerations, the receipt whereof is hereby acknowledged, do(es) hereby waive and release any and all lien or claim of, or right to, lien, under the statutes of the state of Illinois, relating to mechanics' lien, with respect to and on said above-described premises, and the improvements thereon, and on the material, fixtures, apparatus or machinery furnished, and on the moneys, funds or other considerations due or to become due from the owner, on account of labor services, material, fixtures, apparatus or machinery furnished, or which may be furnished at any time hereafter, by the undersigned for the above-described premises. *

Dated *

Company Name *

Type Name and Title *

Signature *

Subscribed and sworn to before me this (date). *

Notary Public

Name

Partial Lien Waiver

*REQUIRED

State of *

County of *

File *

Whereas the undersigned has been employed by (employer) to furnish (entry) for the premises known as (address) of which (name) is the owner. *

Dated *

Company Name *

Type Name and Title *

If you have contracted for labor or materials on this job you must complete the Contractor’s Affidavit.

Contractor’s Affidavit

State of *

County of *

Names

What for

Contract price including extras *

Amount Paid

This Payment

Balance Due

Names

What for

Contract price including extras*

Amount paid

This Payment

Balance Due

Date *

Signature *

Subscribed and sworn to before me this (date). *

Notary Public

*Extras include but are not limited to change orders, both oral and written, to the contract

The names and addresses of all principal suppliers should be listed even if all materials are from fully paid stock and delivered to the site by the subcontractor

Phone

Downloads

Construction – Owner Statement

Construction – Contractor Statement

Final Lein Waiver

Final Supply Lien Waiver

Partial Lien Waiver

LOCATIONS IN ILLINOIS AND FLORIDA

Contact Us

HBW Title has been providing an innovative range of title insurance, escrow closing and
real estate information products and services since 1883.

Feel free to reach out to HBW for all your title and escrow closing needs today. We look forward to working with you!

H.B. Wilkinson Title Co.

321 North Bench Street
Galena, IL 61036

p. 815.777.3318
f. 815.777.1754

For Closing: [email protected]

For Orders: [email protected]

H.B. Wilkinson Title Co.

321 North Bench Street
Galena, IL 61036

p. 815.777.3318
f. 815.777.1754

For Closing: [email protected]

For Orders: [email protected]

“A legacy of quality with a future you can trust.”

“A legacy of quality with a future you can trust.”

Click on the +/- to choose one of the forms to fill out below

Sworn Statement for Owner

If you have contracted for labor or materials on this job you must complete the Contractor’s Affidavit.

Contractor’s Affidavit

If you have contracted for labor or materials on this job you must complete the Contractor’s Affidavit.

Contractor’s Affidavit

Click on the +/- to choose one of the forms to fill out below

Sworn Statement for Owner

If you have contracted for labor or materials on this job you must complete the Contractor’s Affidavit.

Contractor’s Affidavit

If you have contracted for labor or materials on this job you must complete the Contractor’s Affidavit.

Contractor’s Affidavit

Downloads

LOCATIONS IN ILLINOIS AND FLORIDA

Contact Us

HBW Title has been providing an innovative range of title insurance, escrow closing and real estate information products and services since 1883.

Feel free to reach out to HBW for all your title and escrow closing needs today. We look forward to working with you!

H.B. Wilkinson Title Co.

H.B. Wilkinson Title Co.

© Copyright 2020 H.B. Wilkinson Title Co.

HBW Title has been providing an innovative range of title insurance, escrow closing and
real estate information products and services since 1883.