Fill and Sign the Mo Release Lien Form

CONDITIONAL WAIVER AND RELEASE OF LIEN UPON PROGRESS PAYMENT (Mo.S.Ann § 429.005) On this _____ day of ________________ , 20 ______ , the undersigned lienor, in consideration of the sum of $ ___________________ , does hereby waive and release 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 Progress 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 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 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 Progress Payment Page 1 of 2 Conditional Waiver and Release of Lien Upon Progress Payment Page 2 of 2