RECEIPT AND WAIVER OF MECHANIC’S LIEN RIGHTS
The undersigned hereby acknowledges receipt of the sum of $________________________.
as partial payment for labor, skill and material furnished
as payment for all labor, skill and material furnished or to be furnished (except the sum of
______________________________ retainage or holdback)
as full and final payment for all labor, skill and material furnished or to be furnished
to the following described real property: (legal description, street address or project name)
and for value received hereby waives all rights acquired by the undersigned to file or record
mechanic's lien against said real property for labor, skill or material furnished to said real
property (only for the amount paid if Box 1 is checked, and except for retainage shown if Box 2
is checked). The undersigned affirms that all material furnished by the undersigned has been paid
for, and all subcontractors employed by the undersigned have been paid in full, EXCEPT:
Fed. Tax ID No. _____________________
Please complete and sign this lien waiver on the line above. Once it has been fully signed, please return this
original, signed lien waiver to us in the enclosed self-addressed stamped envelope. If you have any questions,
please call ___________________________ at _______________________________. Thank you.