Fillable Partial Waiver Of Lien Form - State Of Illinois printable pdf download

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PARTIAL WAIVER OF LIEN

STATE OF ILLINOIS

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SS.

COUNTY OF ____________________

TO CEFCU and ALL OTHERS TO WHOM IT MAY CONCERN:

WHEREAS, the undersigned has been employed by __________________________________________________________________________

to furnish __________________________________ for the premises commonly known as ______________________________________________

in the City of _______________________ County of ______________ and State of Illinois, of which ____________________________________

is/are the owner(s).

NOW THEREFORE, the undersigned, for and in consideration of ______________________________________________($______________),

Dollars, and other good and valuable consideration, the receipt whereof is hereby acknowledged, do(es) hereby waive and release any and all lien or

claim of, or right to, lien, under the statutes of State of Illinois, relating to mechanics' liens, with respect to and on said above-described premises, and

the improvements thereon, and on the material, fixtures, apparatus or machinery furnished, and on the moneys, funds or other considerations due or

to become due from the owner(s), on account of all labor, services, material, fixtures, apparatus or machinery furnished to this date by the

undersigned to or for the above-described premises, including extras.

Given under my hand and seal this __________ day of ____________________, 20________.

_______________________________________________________

[Name of Contractor]

By:____________________________________________________

[Name/Title (Print)]

________________________________________________________

[Signature]

[Date]

________________________________________________________________________________________________________________________

CONTRACTOR’S AFFIDAVIT

STATE OF ILLINOIS

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SS.

COUNTY OF ____________________

TO CEFCU and ALL OTHERS TO WHOM IT MAY CONCERN:

The undersigned (name)___________________________________________________ being fully sworn, deposes and says that he or she

is (position)________________________________________________ of (company name) _________________________________________ who

is the contractor furnishing _______________________________________ for the premises commonly known as ___________________________

_______________________________________________________________________ in the City of ____________, County of _______________

and State of Illinois of which ____________________________________is are the owner(s). That the total amount of the contract, including extras,

is $____________________________ on which he or she has received payment of $_______________________ prior to this payment. That all

waivers are true, correct and genuine and delivered unconditionally and that there is no claim either legal or equitable to defeat the validity of said

waivers. That the following are the names and addresses of all parties who have furnished material, services and/or labor for said work and all

parties having contracts or subcontracts for specific portions of said work or for material entering into the construction thereof and the amount due or

to become due to each, and that the items mentioned include material, services and/or labor required to complete said work according to the plans and

specifications:

Name and Address of

Retenti

Balance Due or To

Person Supplying

Contract Price

Amount Paid to

Amount of this

Become Due After

Kind of Work or Material

Material, Services