Unconditional Waiver And Release On Progress Payment Form (Page 3 of 3) in pdf

Unconditional Waiver And Release On Progress Payment Form Page 3

Date ____________________________

_________________________________ (Company name)

By ______________________________ (Signature)

_________________________________ (Title)

STATE OF <where signed > '

COUNTY OF <where signed> '

BEFORE ME, the undersigned, a Notary Public, on this day

personally appeared <NAME OF PERSON SIGNING>, known to me to be

the person and officer whose name is subscribed to the foregoing

instrument, and acknowledged to me that the same was the act of

said <NAME OF COMPANY>, a corporation, or its successors, and

that he/she executed the same as the act of such corporation for

the purposes and consideration therein expressed, and in the

capacity stated.

Given under my hand and seal of office, this the

day

of <MONTH, YEAR>.

__________________________________

Notary Public, State of __________

My Commission expires: _____________

D:\DOCUMENTS AND SETTINGS\GLENN\MY DOCUMENTS\TOM SHIELS\STATUTORY RELEASE FORMS\UNCONDITIONAL

WAIVER AND RELEASE-PROGRESS PAYMENT FORM.DOC

Unconditional Waiver And Release On Progress Payment Form Page 3