Owners Payment Authorization
To: First Community Title Services, Inc.
Re: Escrow No. ____________
Date: __________
Gentlemen:
The undersigned hereby authorizes and directs First Community Title to disburse the sum of $_____________________ as requested on the Sworn General Contractor’s/Owner’s Statement dated _________________ in accordance with the terms of the Construction Loan Escrow and Disbursing Agreement.
The undersigned also authorizes and directs First Community Title to disburse the below mentioned amounts, if any, to those designated contractors from the above captioned escrow.*
I certify that there are no other contracts with amounts due, to become due or payable let by me for lienable services.
I have no knowledge of any amounts owed for construction or materials, including extras and change orders other than those listed herein and/or on the General Contractor’s Statement.
_____________________________, Owner
_____________________________, Owner
*(Note to Owners: Total contract amount, amount previously paid, amount due this payment, and balance due should also be verified before the above payment is authorized.)