Lien Waiver And Release printable pdf download

Lien Waiver and Release

Revised 10/29/2014

The undersigned ("Affiant"), being first duly sworn, deposes and says:

Affiant is a contractor, subcontractor, materialman or an officer, agent or representative of same, who or which has

furnished services, labor or materials ("Contractor") in the construction, repair, and/or replacement (the "Work") of

improvements upon real property owned by:

Owner’s/Borrower’s Name: _____________________________________ Reference No: ______________

Property Address: ___________________________________________________________________________

Contractor Has Furnished:

__________________________________________________________________________________________________

(Describe nature of Labor/Materials on the above project)

Total Completed:

$______________________________

Holdback:

$______________________________

Total Earned Less Retention (Subtotal):

$______________________________

Net Draw Amount (Amount of Check):

$______________________________

A holdback identified above will be retained from the lien release amount until issuance of the Final Release Notice of all

construction categories, and the final title policy.

The total of all changes for, and in connection with, all such services, labor and/or materials performed or furnished by

Contractor will be paid in full to Contractor upon receipt of completed lien waiver and any other required documentation.

Affiant, as Contractor or as an officer, agent, or representative of Contractor, hereby acknowledges complete satisfaction

of and forever waives and releases all claims of every kind against Owner or the property referred to above or any other

property of Owner, including, but not limited to all liens and claims of liens, that Contractor may have as a result of or in

connection with the performance or furnishing of such services, labor and/or materials upon receipt of payment.

Affiant, as Contractor or as an officer, agent or representative of Contractor, further represent and warrants that (a)

Contractor has not assigned and will not assign any claim for payment or any right to perfect a lien against said property;

(b) all persons or entities who furnished services, labor or materials to Contractor in connection with the Work have been

paid all amounts to which they have or may become entitled therefore; and (c) Contractor's portion of the Work is fully

completed in accordance with the final plans and specifications therefore.

This document and its subject matter are the sole property of Plaza Home Mortgage, Inc., and is intended for its use only. Any unauthorized use,

dissemination, or distribution of this document or its subject matter is strictly prohibited.

Lien Waiver and Release rev. 01

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9/19/2014

Lien Waiver And Release