815 ILCS 135/3

Such completion certificate shall be signed by the obligor of the loan and by the contractor performing the aforesaid work, shall be dated, and shall be in substantially the following form:

COMPLETION CERTIFICATE

We, the undersigned, being respectively the obligor and contractor, do hereby certify that the contractor has performed labor or delivered materials or both to (address of property) ...., in connection with a contract to improve, create an addition to, repair or remodel such property, and that as of this date the value of the labor performed and materials delivered is $....

We do further certify that in connection with such contract there remains labor to be performed, and materials to be delivered, of the value of $....

This Certificate is signed on (insert date).

.... (Obligor)

.... (Contractor)