Lien Waiver - Payment Confirmation - Wyoming

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STATE OF WYOMING
Lien Waiver
Project ______________________ Steed Construction, Inc. Job No.____________
 
(Pursuant to W.S. §29-10-101)
Note to Lien Claimant: Signing this form has legal
STATE OF ___________)
Wyoming
implications. If you have any questions regarding
how to complete this form or whether it has been
)ss.
properly completed, you should consult an attorney.
LIEN WAIVER
COUNTY OF __________)
To: __________________________
This instrument was acknowledged before me on this
Project: ______________________
___ day of ___________, 20___, by _______________
(name of person) as lien claimant or _______________
From: ________________________
(title, position or type of authority granted by lien
claimant) of _____________________________ (lien
Date: ________________________
claimant).
Payment: $____________________
IN WITNESS THEREOF, I have hereunto set my hand
In consideration of the PAYMENT received to date, the
and affixed my official seal on the day and year last
undersigned does hereby waive, release, and relinquish
above written.
any and all claim and/or right of lien against the project
and the real property improvements thereto for labor
______________________________
and/or materials furnished for use in construction of the
Notarial officer
project; provided however, the undersigned reserves all
claims and/or rights of lien as to monies withheld as
My Commission Expires: ____________
retainage in the amount of $_______________, and any
labor and/or materials hereafter furnished for which
Seal:
payment has not yet been made. The undersigned has not
been paid the sum of $________________ for work
performed and/or materials provided under contract on
this project and retains the right to file a lien against the
property and pursue any and all actions to recover the full
amount due, including any and all equitable claims. The
undersigned acknowledges receipt of payment for work
PAYMENT CONFIRMATION
performed or materials provided and acknowledges that
this waiver may be relied upon by the owner even if the
The undersigned warrants and certifies that the
undersigned accepts payment in uncertified funds and
Payment Amount set forth in the check referenced in
such payment is subsequently dishonored or revoked, in
the Lien Waiver herein was paid to the undersigned by
which case this lien waiver shall remain in full force and
the depository institution on which it was drawn and
effect. The foregoing waiver shall not apply, however, if
that such Lien Waiver is in full force and effect.
payment tendered by the owner is dishonored or revoked.
Dated ____________________________
By:__________________________________
_________________________________ (Company)
Title:_______________________________
By ______________________________ (Signature)
Date:________________________________
Its _________________________________ (Title)
S
C
,
I
.
|
1250
E.
I
E
D
|
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,
ID
83616
|
F:
(208)
378‐7332
|
P:
(208)
378‐7300
 
TEED 
ONSTRUCTION
 
NC
  
 
 
 
RON 
AGLE 
RIVE 
 
AGLE
 
 
 
 
 
 
 
 
 
 
 
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.
 
WWW
TEED
ONSTRUCTION
COM

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