Fill and Sign the Missouri Lien 497313130 Form

CONDITIONAL WAIVER AND RELEASE OF LIEN UPON FINAL PAYMENT (Mo.S.Ann § 429.005) 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: ________________________________________________________________________ ________________________________________________________________________ _______________________________________________________________________ . 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 STATE OF MISSOURI COUNTY OF ______________ On this _____ day of ______________ , 20 _____ , before me personally appeared ___________________________________ , to me known to be the person described in and who executed the foregoing instrument, and acknowledged that he/she executed the same as his/her free act and deed. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my official seal in the county and state aforesaid, the day and year first above written. ______________________________ Notary Public My commission expires: Conditional Waiver and Release of Lien Upon Final Payment Page 1 of 2 _______________ Conditional Waiver and Release of Lien Upon Final Payment Page 2 of 2