Contractor Affidavit


Return To:

Original Contractor: (Name & Address)






Property Owner: (Name & Address)
















Commencement Date:


PURSUANT TO Connecticut General Statute § 49 - 35, notice is hereby given that the above - identified Original Contractor, as the original contractor, has entered into a written contract with the above - identified Property Owner, for the construction, raising, removal or repairing of the building or development of any lot, or the site development or subdivision of any plot of land on a certain construction project located at the above - described and identified Property. The Original Contractor commenced or will commence construction on the project on the above Commencement Date.


Signed by:

Duly Authorized

Signed and Delivered in the presence of:




State of _____________________________ County of ____________________________

Before me, on the _____ day of _______________________, ___ ______ personally appeared ________________________________, agent of the Claimant, signer of the foregoing Certificate, duly acknowledged the execution of the foregoing instrument, that he/she is an agent of the Original Contractor, and that he/she signe d said Instrument on behalf of the Original Contractor, by proper authority, and he/she made solemn oath to the truth of said instrument and that upon information and belief, the amount stated therein is justly due as nearly as the same can be ascertained.

Notary Public

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