Final Sales Tax Affidavit Page 10
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10UNCONDITIONAL
SUB-SUBCONTRACTOR / SUPPLIER
WAIVER AND RELEASE OF LIEN
UPON FINAL PAYMENT
The undersigned lienor, having received the final payment, hereby waives and releases its
lien and right to claim a lien for labor, services or materials furnished to
and Summit Contractors Group, Inc. on the job
Subcontractor’s Name)
of
, to the following described property:
Job Name:
Job Address:
City, State, Zip:
DATED on ___________________________, 20_____.
(Sub-Subcontractor’s / Supplier’s Name)
By: _______________________________
Printed Name________________________
STATE OF FLORIDA
COUNTY OF ___________________
The foregoing instrument was acknowledge before me this___________ day of
______________, 20__, by______________________________, as ______________________
of ________________________________, who is:
(Sub-Subcontractor’s / Supplier’s Name)
_________Personally known
_________Produced Identification
Type of Identification Produced____________________
___________________________________
NOTARY PUBLIC
My Commission Expires_______________
NOTE:
This is a statutory form prescribed by Section 713.20, Florida Statutes
(2001).
Return to: Summit Contractors Group, Inc., 6877 Phillips Industrial Boulevard, Jacksonville, Florida 32256
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