Fill and Sign the Conditional Release Lien Form

Conditional Waiver and Release of Lien Page 1 of 2Prepared by, recording requested by and return to:Name: _____________________Company: _____________________Address:_______________________ City: ____________________State: _____Zip: _________Phone: _________________Fax: ___________________----------------------Above this Line for Official Use Only---------------------Name of Claimant: ________________________________Name of Debtor: ________________________________Amount of Lien: _________________Tax Assessor’s Account Number: _________________Situs Address of Real Property: ________________________________________________________________________ CONDITIONAL WAIVER AND RELEASE OF LIEN UPON PROGRESS PAYMENT On this _____ day of ________________ , 20______, the undersigned lienor, whose address is ______________________________________________________________________, in consideration of the sum of $ ___________________, does hereby waive and release 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 property located at and described as: ________________________________________________________________________________________________________________________________________________ ___________________________________________________________________ (legal description that includes a metes and bounds description; a lot, block, subdivision; the book and page and/or instrument number of a recorded deed where the legal can be found; or a parcel in a partition). 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 received within _____ days of the date hereof, this Conditional Waiver and Release of Lien is void. Conditional Waiver and Release of Lien Page 2 of 2This waiver and release does not cover any retention or labor, services, or materials furnished after the date specified. ______________________________ Signature of Lien Holder ______________________________ Type or Print Name STATE OF OREGONCOUNTY OF _________________ This instrument was acknowledged before me on _______________________ (date) by __________________________________________ (name(s) of person(s)). ______________________________ NOTARY PUBLIC Print Name: ___________________ My Commission Expires: ____________________