Conditional Partial Waiver And Release Of Lien Form, Form W-9 - Request For Taxpayer Identification Number And Certification Page 5

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UNCONDITIONAL WAIVER AND RELEASE OF LIEN UPON PROGRESS PAYMENT
The undersigned, in consideration of the progress payment in the amount of $
hereby waives and releases its lien and right to claim a lien for labor, services, or materials
through
to Live Oak Contracting, LLC. on the job of
to the following property:
Job Name:
Address:
This waiver does not cover any retention or labor, services, or materials furnished after the
date specified.
(Subcontractor’s Name)
(By)
(Date)
(Printed Name & Title)
S ubscribed and sworn to, before me this date of
,20 ___________________
Notary Public
STATE OF______________________________________ COUNTY OF ______ ___ _____________ _________________
My Commission Expires: __________________________________
Note: This is a statutory form prescribed by §713.20, Florida Statutes (2011).

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