Laserfiche WebLink
Affiant has full knowiedge of the statements contained herein and the basis therefore <br /> and ,h�s been duly authorized by Claimant to make said statements. Affiant <br /> acknowledges that Surety is relying on the representations made herein, in part, to <br /> review the claim. <br /> The following information is furnished to the Surety in support of affiant's claim, and it is <br /> unclerstood that in furnishing this form the acceptance and/or retention by the Surety <br /> does not constitute a waiver of any of the terms and conditions of the surety's bond nor <br /> of any rights or defenses the Surety has or may have, and is not and shall not be <br /> deemed to be an admission of liability. <br /> U.S. Pine and Foundry Co. , LLC <br /> � <br /> Na e f Claimant <br /> gy; ��. <br /> Name of A nt <br /> TItl2: Director Corporate CrE3i�: <br /> THIS AFFIDAVIT MUST BE EXECUTED BEFORE A NOTARY PUBLIC <br /> StBte Of �labama <br /> COunty of Jefferson <br /> On this 21 day of March � 20 11 � before me, the undersigned notary <br /> public, personally appeared T.V. Cwynar (name of document signer), <br /> I�'oved to me t rou� satisfactory evidence of identification which was <br /> l�O�7��1 �iowh � i►'o�i�'ti , to be the person who signed the preceding <br /> or attached document in my presence, and who swore or affirmed to me that the <br /> contents of the document are truthful and accurate to the best of (his)(her) knowledge <br /> and belief. <br /> Witness y hand and al. <br /> � M•� <br /> i��atu� �if�IVbtary) <br /> a+; C: p : <br /> � My�" . siar�},,ek�ires: ---�1 o�D =- — <br /> , � � <br /> � i �i 1 ,�`�;� <br /> � �j,���'•.C! LIC STAIE OF ALABAAAA AT LAR(3E <br /> ( • :.. y. ISSION EXPIRES: Nov 20.2014 <br /> �,��� s- u riora�v we�.�c uHo�wAireRs <br /> .... ;,�: <br />