Contractor'S Affidavit - Final Lien Waiver Form

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FINAL LIEN WAIVER
STATE OF _________________________
FILE # _________________
COUNTY OF _______________________
WHEREAS
THE UNDERSIGNED HAS BEEN EMPLOYED BY _____________________________________________________________ TO FURNISH
_______________________________ FOR THE PREMISES KNOWN AS ________________________________________________________ OF WHICH
___________________________________________________________ IS THE OWNER.
THE
UNDERSIGNED, FOR AND IN CONSIDERATION ______________________________________ AND _____________________/100 DOLLARS
($________________), AND OTHER GOOD AND VALUABLE CONSIDERATIONS, THE RECEIPT WHEREOF IS HEREBY ACKNOWLEDGED, DO(ES)
HEREBY WAIVE AND RELEASE ANY AND ALL LIEN OR CLAIM OF, OR RIGHT TO, LIEN, UNDER THE STATUTES OF THE STATE OF ILLINOIS,
RELATING TO MECHANICS' LIEN, WITH RESPECT TO AND ON SAID ABOVE-DESCRIBED PREMISES, AND THE IMPROVEMENTS THEREON, AND ON
THE MATERIAL, FIXTURES, APPARATUS OR MACHINERY FURNISHED, AND ON THE MONEYS, FUNDS OR OTHER CONSIDERATIONS DUE OR TO
BECOME DUE FROM THE OWNER, ON ACCOUNT OF LABOR SERVICES, MATERIAL, FIXTURES, APPARATUS OR MACHINERY HERETOFORE
FURNISHED, OR WHICH MAY BE FURNISHED AT ANY TIME HEREAFTER, BY THE UNDERSIGNED FOR THE ABOVE-DESCRIBED PREMISES.
THAT THERE ARE NO OTHER CONTRACTS FOR SAID WORK OUTSTANDING, AND THAT THERE IS NOTHING DUE OR TO BECOME DUE TO ANY
PERSON FOR MATERIAL, LABOR OR OTHER WORK OF ANY KIND DONE OR TO BE DONE UPON OR IN CONNECTION WITH SAID WORK OTHER
THAN ABOVE STATED.
DATED
COMPANY NAME: ____________________________
______________________
SIGNATURE & TITLE:
_____________________________________________
Type or Print Name and Title __________________________________________________
IF YOU HAVE CONTRACTED FOR LABOR OR MATERIALS ON THIS JOB YOU MUST COMPLETE
'
.
THE CONTRACTOR
S AFFIDAVIT
STATE OF _______________________
CONTRACTOR'S AFFIDAVIT
COUNTY OF _____________________
TO WHOM IT MAY CONCERN:
SUBCONTRACTOR/SUPPLIER
THE UNDERSIGNED, BEING DULY SWORN, DEPOSES AND SAYS THAT HE IS
OF THE
SUBCONTRACTOR/GENERAL CONTRACT
OR
WHO IS THE CONTRACTOR FOR THE _______________________________ WORK ON THE
BUILDING LOCATED AT ______________________________________ OWNED BY ________________________________________. THAT THE
TOTAL AMOUNT OF THE CONTRACT INCLUDING EXTRAS IS __________________________________ ($_________________) ON WHICH HE 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 OF ALL PARTIES WHO HAVE FURNISHED
MATERIAL OR LABOR, OR BOTH, FOR SAID WORK AND ALL PARTIES HAVING CONTRACTS OR SUB CONTRACTS 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 ALL LABOR AND MATERIAL REQUIRED TO COMPLETE SAID WORK ACCORDING TO PLANS AND
SPECIFICATIONS:
NAMES
WHAT FOR
CONTRACT PRICE
AMOUNT
THIS
BALANCE
INCLUDING EXTRAS*
PAID
PAYMENT
DUE
TOTAL LABOR & MATERIAL INCLUDING EXTRAS* TO COMPLETE
THAT THERE ARE NO OTHER CONTRACTS FOR SAID WORK OUTSTANDING, AND THAT THERE IS NOTHING DUE OR TO BECOME DUE TO ANY
PERSON FOR MATERIAL, LABOR OR OTHER WORK OF ANY KIND DONE OR TO BE DONE UPON OR IN CONNECTION WITH SAID WORK OTHER
THAN ABOVE STATED.
DATE: ____________________
SIGNATURE: _____________________________________________
SUBSCRIBED AND SWORN TO BEFORE ME THIS _______ DAY OF ___________________20____.
________________________________________
NOTARY PUBLIC
*EXTRAS INCLUDE BUT ARE
The names and addresses of all principal suppliers
NOT LIMITED TO CHANGE
should be listed even if all materials are from fully paid
ORDERS, BOTH ORAL &
stock and delivered to the site by the subcontractor
WRITTEN, TO THE CONTRACT

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