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Fill and Sign the Final Waiver Form 497306014

Fill and Sign the Final Waiver Form 497306014

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FINAL LIEN WAIVER STATE OF ILLINOIS COUNTY OF ________________ ____________________ , 20 _____ TO ALL WHOM IT MAY CONCERN: Whereas, the undersigned, __________________________________ , has been employed by ____________________________________ , contractor of _________________________________ , the owner of the premises, hereinafter described to furnish ______________________________________ for the said premises, which are known as _________________________________ , in County of ____________________ , Illinois, and which are also described by legal description as: _______________________________________________________________________ in the County of _______________ , State of Illinois; Now, therefore, the undersigned, for and in consideration of the sum of ________________ Dollars, and other good and valuable considerations, the receipt whereof is hereby acknowledged by the undersigned, do hereby waive and release any and all lien or claim of, or right to, lien, under the statutes of the State of Illinois, relating to mechanics' liens, with respect to and on said above-described premises, and the improvements thereon, and on the material, fixtures, apparatus or machinery furnished, and on the moneys, funds or other considerations due or to become due the contractor from the owner, on account of labor, services, material, fixtures apparatus or machinery heretofore furnished, or which may be furnished at any time hereafter, by the undersigned, to or on account of the said contractor of the said owner, for the above- described premises. _________________________ Signature _____ ____________________ Print or Type Name Final Lien Waiver Page 1 of 2 State of _____________________ County of ___________________ Given under the hand and seal of the undersigned, this ____ Day of ________, 20___. _____________________________ Notary Public (SEAL) Printed Name: _________________ My Commission Expires: _____________________ Final Lien Waiver Page 2 of 2

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