Fill and Sign the For the Work Described Herein Form

Conditional Waiver and Release of Lien Page 1 of 2Prepared 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 FINAL PAYMENTOn this _____ day of ________________ , 20______, the undersigned lienor, in consideration of the final payment in the amount of $_________________, hereby waives and releases 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 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 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 Conditional Waiver and Release of Lien Page 2 of 2State of New JerseyCounty of ______________, ss: I CERTIFY that on _______________, ________ , ___________________________________ personally came before me and acknowledged under oath to my satisfaction, that this person (or if more than one, each person): a) is named in and personally signed the attached document; andb) signed and delivered this document as his/her/their act and deed; and c) executed this document under oath after being duly sworn. _____________________________ Signature______________________________Notary PublicPrint Name: ___________________ My commission expires:______________