Fill and Sign the Florida Conditional Form

Conditional Waiver and Release of Lien Page 1 of 2 Prepared by, recording requested by and return to: Name: ___________________ Company: ___________________ Address: _____________________ City: __________________________ State: _____ Zip: _____________ Phone: _____________________ Fax: _______________________ ----------------------Above this Line for Official Use Only--------------------- CONDITIONAL WAIVER AND RELEASE OF LIEN UPON PROGRESS PAYMENT- INDIVIDUAL The undersigned lienor, in consideration of the sum of $ ___________________, hereby waives and releases its 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 materia ls furnished after the date specified. DATED on _____ day of ____________________, 20_____. Conditional Waiver and Release of Lien Page 2 of 2 Lienor's Name _________________________ Address ____________________________________ ______________________________________ By ___________________________________ Printed Name ___________________________ STATE OF ___________ COUNTY OF _____________ Sworn to (or affirmed) and subscribed before me this _____ day of _________________, 20______ by _________________________ (name of person making statement) who is personally known to me or produced _________________________ as identification, and who did take an oath. ____________________________ NOTARY PUBLIC Printed Name of Notary _________________________ Commission Expires _________________________