Fill and Sign the I Certify that on Form

Unconditional 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--------------------- UNCONDITIONAL WAIVER AND RELEASE OF LIEN UPON FINAL PAYMENT On 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: _______________________________________________________________________________________________________________________________________________________________________________________________________________________ __________________________________ Signature of Lien Holder__________________________________ Type or Print Name Unconditional Waiver and Release of Lien Page 2 of 2 State of New Jersey County 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; and b) 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 Public Print Name: ___________________ My commission expires:________________