Fill and Sign the Florida Conditional Waiver and Release of Lien Upon Final Form

Conditional Waiver and Release of Lien Upon Final Payment Page 1 of 2 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 affirms the undersigned’s waive r and release of 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 up on 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 Sworn and subscribed to before me this ______ day of ___________________ ___, 20_______. ____________________________ Signature of Notary Public ____________________________ Type or Print Name [Notary Seal] My commission expires: ________________ Conditional Waiver and Release of Lien Upon Final Payment Page 2 of 2 Certificate of Delivery I, _____________________________________, hereby certify that I have delivered this day a true and correct copy of the foregoing to ___________________________________ by: ( ) Personal Service ( ) Registered or Certified Mail, return receipt requested ( ) Mailing a true and correct copy of same by certified U.S. mail, postage prepaid, return receipt requested to ___________________________, who is the lien claimant located at ______________________________________. So certified this the ______ day of ___________________, 20____. ________________________ Signature