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Construction Final Lien Waiver

State of Illinois

ss.

County

ESCROW #

To Whom It May Concern:

WHEREAS the undersigned has been employed by

to furnish

for the premises known as

of which

is the owner.

The undersigned, for and in consideration of

) Dollars, and other good and valuable consideration, the receipt whereof is hereby acknowledged,

do(es) hereby waive and release any and all lien or claim of, or right to, lien, under the statures of the State of Illinois, relating

to mechanics’ liens, with respect to and on said above-described premises, and the improvements thereon, and on the material,

fixtures, apparatus or machinery furnished, and on the monies, funds or other considerations due or to become due from the

owner, on account of labor services, material, fixtures, apparatus or machinery, heretofore furnished, or which may be

furnished at any time hereafter, by the undersigned for the above-described premises.

Date

Company Name

Address

Signature and Title

CONTRACTOR’S AFFIDAVIT

State of Illinois

ss.

County

To Whom It May Concern:

The undersigned, (Name)

being

duly sworn, deposes and says that he or she is (Position/Title)

of (Company Name)

who is the contractor furnishing

work on the building located at

owned by

that the total amount of the contract including extras

is $

on which he or she has received payment of

(CONTRACT AMOUNT)

prior to this payment. That all waivers are

(PREVIOUS PAYMENT)

true, correct and genuine and delivered unconditionally and that there is no claim either legal or equitable to defeat the

validity of said waivers. That the following are the names of all parties who have furnished material or labor, or both, for said

work and all parties having contracts or sub contracts for specific portions of said work or for material entering into the

construction thereof and the amount due or to become due to each, and that the items mentioned include all labor and material

required to complete said work according to plans and specification:

SUPPLIER INFORMATION & MATERIAL WAIVER

NAME/ADDRESSES

WHAT FOR

CONTRACT

THIS PAYMENT

BALANCE TO

PRICE

PAYMENT

BECOME DUE

TOTAL LABOR AND MATERIAL

TO COMPLETE

That there are no other contracts for said work outstanding, and that there is nothing due or to become due to any person for material, labor or other work of

any kind done or to be done upon or in connection with said work other than above stated.

Date

Signature

Subscribed and sworn to before me this

day of

Notary Public

Construction Final Lien Waiver

Stewart Title - Illinois Division (01/2015)

Construction Final Lien Waiver

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