Release Of Lien Form - Partial - Rpr Construction


On ________________ the State of Texas, County of Smith, RPR Construction Company, Inc., entered into
contract with the undersigned __________________________________________________ to furnish labor and/or
materials and/or equipment in connection with certain improvements to real property located in
____________________________________________ and Owned by ___________________ such improvements
being known as ________________________________ or which RPR Construction Company, Inc. is the General
The labor and/or material and/or equipment furnished by the undersigned are described as
_______________________ and referred to hereinafter as the “work”.
Based on receipt of __________________________________________________________________ DOLLARS,
($_________________________) for the work furnished, the sufficiency of which is acknowledged, the
undersigned does hereby waive and release any mechanic’s lien or materialmen’s lien or claims of lien, including
any constitutional lien or claim thereto, property and/or improvements thereon account of any work furnished or to
be furnished by the undersigned, its materialmen, suppliers and subcontractors.
The undersigned further certifies and warrants that all outstanding bills, claims, charges and obligations incurred by
the undersigned with materialmen, laborers, subcontractors or other persons who would be entitled to assert a claim
under applicable law against the real property have been paid in full or will, by these proceeds, be paid in full for
work done or materials furnished through date of this release. The undersigned agrees to indemnify and hold RPR
Construction Company, Inc. and Owner harmless from any and all claims, liens actions or causes of action arising
out of or having to do with the failure of the undersigned to make the payments called for under this paragraph or
for any portion of this paragraph that is untrue. The undersigned acknowledges that Company is relying upon the
representations contained in this Release and would not have released the funds identified in this Release to the
undersigned but for this Partial Release of Lien.
(Company Name)
(Printed Name & Title)
Check One:
[ ] Individual
[ ] Partnership
[ ] Corporation
Before me, the undersigned, personally appeared _____________________________________________________
on this day, known to me to be the person whose name is subscribed to the foregoing instrument and acknowledged
to me that he/she executed the same for the purposes and consideration therein expressed and upon being duly
sworn, stated that he/she has read the foregoing instrument and it is true and correct.
Subscribed and sworn before me this ___________________ day of __________________________ , 20______
Notary Public: _________________________________ in and for _____________________________(County)
___________________________ (State).
My Commission Expires: __________________________________


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