Fill and Sign the Mississippi Release Lien Form

Unconditional Waiver and Release of Lien Upon Progress Payment On this _____ day of ________________ , 20 ______ ,the undersigned lienor, in consideration of the sum 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 waiver and release does not cover any retention or labor, services, or materials furnished after the date specified. __________________________________ Signature of Lien Holder _____ _____________________________ Type or Print Name STATE OF MISSISSIPPI COUNTY OF _________________ Personally appeared before me, the undersigned authority in and for said county and state, on this ______ day of __________________ , 20 ______ , within my jurisdiction, the within named ______________________________ , who acknowledged that he/she/they executed the above and foregoing instrument. Notary Public My commission expires:       Type or Print Name Unconditional Waiver and Release of Lien Page 1 of 1