Fill and Sign the Conditional Waiver and Release Upon Final Payment Individual Maine Form

Conditional Waiver and Release of Lien Upon Final Payment- Individual 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: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ _________________ . 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 STATE OF MAINE COUNTY OF ____________________ The foregoing instrument was acknowledged before me this __________________________ (date) by ___________________________________ (name of person acknowledged). ___________________________________ Signature of Notary Public ___________________________________ Name of Notary Public Notary Public, State of Maine My commission expires: ____________________ Conditional Waiver and Release of Lien Upon Final Payment Page 1 of 1