Fill and Sign the Florida Waiver Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: ___________________ Company: ___________________ Address: _____________________ City: __________________________ State: _____ Zip: _____________ Phone: _____________________ Fax: _______________________ WAIVER AND RELEASE OF LIEN UPON FINAL PAYMENT- INDIVIDUAL The undersigned lienor, in consideration of the final payment in the amount 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: ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ . DATED on _____ day of ___________________ , 20 _____ . Lienor's Name _________________________ Address _______________________________ By _________________________ Printed Name _____ _____________________ Waiver and Release of Lien Page 1 of 2 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 _________________________ Waiver and Release of Lien Page 2 of 2