Conditional Affidavit And Waiver Of Lien printable pdf download

Conditional Affidavit And Waiver Of Lien

CONDITIONAL AFFIDAVIT AND WAIVER OF LIEN

(Payment to Follow)

_______ PARTIAL

_________FINAL

_________________________being duly sworn states that he/she is an ___________________

of ________________________ having contracted with _____________________________ to

furnish certain materials and/or labor for a project known as _________________________ located

at _________________________________________________________________________

and does further state that the amount due from the Owner in the sum of

___________________________________________________ ($____________)

THEREFORE, the undersigned waives and releases unto the Owner of said premises any and all lien

or claim whatsoever on the above-described property and improvements thereon on account of labor or

material or both, furnished by the undersigned thereto, and further certifies that no other party has any

claim or right to a lien on account of any work performed or material furnished to the undersigned for

said project, and with the scope of this affidavit and waiver.

____________________________

Company Name

____________________________

Authorized Representative

____________________________

Printed Name and Title

WITNESS MY HAND AND NOTARY SEAL, this ___________ day of _______________________

______________________________________

My Commission Expires: ________________

______________________________________

County of Residence: ___________________

Conditional Affidavit And Waiver Of Lien