Receipt And Waiver Of Mechanics Lien Rights Form printable pdf download

Receipt And Waiver Of Mechanics Lien Rights Form

RECEIPT AND WAIVER OF MECHANIC’S LIEN RIGHTS

Date: ______________________

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:

____________________________________

By: ________________________________

Its: ________________________________

Fed. Tax ID No. _____________________

INSTRUCTIONS:

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.

Receipt And Waiver Of Mechanics Lien Rights Form