Contractor/subcontractor Partial Release And Lien Waiver Template
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1CONTRACTOR/SUBCONTRACTOR
PARTIAL RELEASE AND LIEN WAIVER
Date:
___________________________
Contract Date:
_____________________
Project:
___________________________
Contract Price:
_____________________
Address:
___________________________
Net Extras & Deductions:
_____________________
City:
___________________________
Adjusted Contract Price:
_____________________
County:
___________________________
Amount Previously Paid:
_____________________
State:
___________________________
Current Payment Due:
_____________________
Owner:
___________________________
Balance Due:
___________________
Contractor:
___________________________
The undersigned, in consideration of payment to it on account of the attached requisition number _________,
hereby unconditionally releases, waives and relinquishes any and all liens, rights of lien and claims now
existing in connection with the above-referenced Project for labor, materials or equipment furnished or work
performed and requisitioned by the undersigned through the last date covered by said requisition subject only to
clearance of the bank funds in payment thereof.
The undersigned further covenants and agrees that it will not claim or file a mechanic’s lien or other lien in
connection with the Project or against any fund applicable thereto for any of the labor, material or equipment
furnished and work performed by the undersigned and requisitioned through the date of the attached requisition.
IN WITNESS WHEREOF, the contractor or subcontractor named below has executed this Partial Release and
Lien Waiver this _____ day of _____________, 20___.
CONTRACTOR/SUBCONTRACTOR:
_________________________________
Signature: _________________________
Print Name: _______________________
Title:_____________________________
STATE OF NEW YORK
)
) ss.:
COUNTY OF ___________)
On this ____ day of ____________, in the year 20__, before me personally came
_____________________________, to me known, who, being by me duly sworn, did depose and say that
he/she resides at _____________________________, that he/she is the ___________________ of the
_________________________, the corporation described in and which executed the foregoing Partial
Release and Lien Waiver, and that he/she signed his/her name thereto by authority of the board of directors
of the corporation.
______________________________
Notary Public
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