Fill and Sign the Conditional Lien Waiver Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: _____________________ Company: _____________________ Address: _______________________ City: ____________________ State: _____ Zip: _________ Phone: _________________ Fax: ___________________ CONDITIONAL WAIVER AND RELEASE OF LIEN UPON FINAL PAYMENT On this _____ day of ________________ , 20 ______ , the undersigned lienor, in consideration of the final payment in the amount of $ _________________ , hereby waives and releases his or her lien and right to claim a lien for labor, services or materials furnished through _________________________________ , 20 _____ , to _________________________ (customer) on the job of _________________________ (owner of property) to the following described property: ________________________________________________________________________ ________________________________________________________________________ _______________________________________________________________________ (if using the description contained in or shown by one or more maps, plats, descriptions, deeds, mortgages or other instruments of record in the office of the county clerk of the county in which the affected real estate is located, the description must include the time and place of filing or recordation of the instrument containing the description referred to, or other similar information, to locate and identify the instrument containing the description). This Conditional Waiver and Release of Lien Upon Final Payment is conditioned upon the undersigned receiving collected funds in the amount of $ ___________________ for the work described herein. Should these funds not be received within _____ days of the date hereof, this Conditional Waiver and Release of Lien is void. This waiver and release covers the final payment to the undersigned for all labor, services, equipment, or material furnished on the job. Before any recipient of this document relies on it, the party should verify evidence of payment to the undersigned. __________________________________ Signature of Lien Holder _____ _____________________________ Type or Print Name Conditional Waiver and Release of Lien Page 1 of 2 State of New Mexico County of __________________ This instrument was acknowledged before me, on the ______ day of __________________ , 20 ______ , by ____________________________________ . (SEAL) Notary Public My commission expires:       Type or Print Name Conditional Waiver and Release of Lien Page 2 of 2