8/18/2019 Lien Release

1/1

WAIVER & RELEASE OF LIEN

PROJECT:

OWNER:

Invoice or Job # 

WHERE AS THE UNDERSIGNED Contractor, Subcontractor, Supplier, Architect or Engineer, other

has provie labor, services, !aterials or e"uip!ent, #or the above pro$ect, uner an agree!ent %ith 

Section A: (check and initial only one of the following)

 PARTIAL WAIVER AND RELEASE: IN CONSIDERATION OF PARTIAL PAYMENT  for labor, services, materials or equipment

provided in the amount of $  covering the following Partial Payment Request(s) or Invoices(s) (!ttach additional pages ifnecessary)"

#!% P!& R%'% or I*+I-% *./%R !.*  0  0  $ (month)0 (day)0 (year) 

ogether with any previous payments(s) already received, but e1cluding any retainage or any labor, services, materials or equipmentprovided after the date of 0

 

0 

"  (month)0 (day)0 (year) OR 

  FINAL WAIVER AND RELEASE: IN CONSIDERATION OF FINAL PAYMENT for all labor, services, materials or equipment providedin the amount of $

 

for this 2ob only"

#!% P!& R%'% or I*+I-% *./%R !.* 

0 

0 

$ 

(month)0 (day)0 (year)  33333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333 THE UNDERSIGNED D&ES HERE'( WAI)E AND RE*EASE all bon clai!s, liens, or clai!s or right o# lien, statutor+ or other%ise, against the propert+, pro$ect&%ners an an+ sureties, #or labor, services, !aterials or e"uip!ent, as provie b+ the Unersigne, but onl+ to the e-tent o# pa+!ent receive, as inicate above anas li!ite belo%.

Section B: /chec0 an initial onl+ one o# the #ollo%ing1

  CONDITIONAL RELEASE: THIS WAIVER AND RELEASE IS CONTINGENT UPON RECEIPT OF PAYMENT an #inal ban0 clearance o# saire!ittance in the above a!ount The re!ittance ienti#ie as pa+!ent an enorse b+ the Unersigne !ar0e 2pai3 or other%ise cancelle b+ the ban0 against%hich sai re!ittance %as ra%n, shall constitute conclusive proo# that sai invoice or pa+ re"uest %as pai an that pa+!ent thereo# %as receive b+ the Unersigne,an thereupon, this %aiver an release shall beco!e e##ective auto!aticall+ %ithout the re"uire!ent o# an+ #urther act, ac0no%leg!ent or receipt on the part o# theUnersigneADDITI&NA*(, THE UNDERSIGNED AC4N&W*EDGES RECEI5T o# the total a!ount 6  in previous pa+!ent an oes hereb+ grant unconitional releaseo# all above escribe clai!s #or that a!ountOR 

  UNCONDITIONAL RELEASE: THE UNDERSIGNED ACKNOWLEDGES RECEIPT OF PAYMENT in the above a!ount #or labor, services,!aterials or e"uip!ent as escribe herein, an oes hereb+ grant this release unconitionall+

 333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333 THE 5ERS&N SIGNING belo% oes hereb+ certi#+ that he or she is #ull+authori7e an e!po%ere to e-ecute this instru!ent an to bin the State o#.Unersigne hereto, an oes in #act so e-ecute this instru!ent

Count+ o#. C&85AN( NA8E.

Subscribe an s%orn to be#ore !e this

ADDRESS. a+ o# 9:;<

 N&TAR( 5U'*IC.

SIGNED. ============================== 8+ Co!!ission E-pires.

SIGNED. =======================================TIT*E.