Contractor Lien Waiver

Contractor Lien Waiver.doc (81.1 KiB)

 

 


Contractor Lien Waiver

 

_________________ County
_________________ State

___________________________        ___________________________
Customer Name                Customer Address

___________________________        ___________________________
Customer City/State/Zip            Customer Phone Number

___________________________        ___________________________
Job Location                    Date

Contractor: ______________________________________________________
Contractor Address ________________________________________________
Description of work completed to date: ________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

Payments received to date: $___________
Payment received on this date: $_________

The Contractor signing below acknowledges receipt of all payments stated above. These payments are in compliance with the written contract between the parties above. The Contractor signing below hereby states payment for all work done to this date has been paid in full.

The Contractor signing below releases and relinquishes any and all rights available to place a mechanics or material man lien against the subject property for the above described work. All parties agree that all work performed to date has been paid for in full and in compliance with their written agreement.

The undersigned Contractor releases the Customer for any liability from non-payment of material or services extended through this date. The undersigned contractor has read this entire agreement and understands the agreement.

_________________________            _________________
Contractor                        Date

Given under hand and seal this _____day of __________________, 20___.

__________________________                    (SEAL)
Notary

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