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

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 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 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 received 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 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 Progress Payment Page 1 of 2 Conditional Waiver and Release of Lien Upon Progress Payment Page 2 of 2