Fill and Sign the Chapter 713 Section 20 2011 Florida the Florida Senate Form

Conditional Waiver and Release of Lien Upon Progress Payment Page 1 of 2 Conditional Waiver and Release of Lien Upon Progress Payment -- Individual On this _____ day of ________________ , 20 ______ , the undersigned lienor, in consideration of the sum of $ ___________________ , does hereby affirm the undersigned’s waive r and release of his or her lien and right to claim a lien for la bor, services or materials furnished through __________________ , 20 _____ , to __________________________ (customer) on the job of ____________________________________ (owner of property) to the following described property: ________________________________________________________________________ ________________________________________________________________________ ___________________________________________________________________ . This Conditional Waiver and Release of Lien Upon Progress Payment is conditioned upon the undersigned receiving collected funds in the amount of $ ___________________ for the work described herein. Should these funds not be recei ved within _____ days of the date hereof, this Conditional Waiver and Release of Lien is void. This waiver and release does not cover any retention or labor, services, or materials furnished after the date specified. __________________________________ Signature _____ _____________________________ Type or Print Name Sworn and subscribed to before me this ______ day of ______________________, 20_______. ____________________________ Signature of Notary Public ____________________________ Type or Print Name [Notary Seal] My commission expires: ________________ Conditional Waiver and Release of Lien Upon Progress Payment Page 2 of 2 Certificate of Delivery I, _____________________________________, hereby certify that I have delivered this day a true and correct copy of the foregoing to ___________________________________ by: ( ) Personal Service ( ) Registered or Certified Mail, return receipt requested ( ) Mailing a true and correct copy of same by certified U.S. mail , postage prepaid, return receipt requested to ___________________________, who is the lien claimant located at ______________________________________. So certified this the ______ day of ___________________, 20____. ________________________ Signature