Fill and Sign the Nevada Unconditional Final Form

UNCONDITIONAL WAIVER AND RELEASE UPON FINAL PAYMENT- INDIVIDUAL Property Name: __________________________________ Property Location: _______________________________________________________ Undersigned's Customer: __________________________________ Invoice/Payment Application Number: _____________________________ Payment Amount: ________________________ Amount of Disputed Claims: ________________________ The undersigned has been paid in full for all work, materials and equipment furnished to his or her Customer for the above-described Property and does hereby waive and release any notice of lien, any private bond right, any claim for payment and any rights under any similar ordinance, rule or statute related to payment rights that the undersigned has on the above-described Property, except for the payment of Disputed Claims, if any, noted above. The undersigned warrants that he or she either has already paid or will use the money he or she receives from this final payment promptly to pay in full all his or her laborers, subcontractors, materialmen and suppliers for all work, materials and equipment that are the subject of this waiver and release. This the _____ day of _______________ , 20 ______ . ______________________________ Signature _____ _________________________ Type or Print Name Notice: This document waives rights unconditionally and states that you have been paid for giving up those rights. This document is enforceable against you if you sign it, even if you have not been paid. If you have not been paid, use a conditional release form. Unconditional Waiver and Release upon Final Payment Page 1 of 2 State of Nevada County of _______________ This instrument was acknowledged before me on ______________ by ___________________________________ . _________________________ (Signature of notarial officer) (Seal, if any) _________________________ (Title and rank (optional)) (My commission expires (optional): _______ ) Certificate of Delivery I, _______________________________________ , hereby certify that I have delivered this day a true and correct copy of the foregoing to ______________________________________ by: ( ) Personal Service ( ) Mailing a true and correct copy of same by certified U.S. mail, postage prepaid, return receipt requested to _________________________________ . So certified this the _____ day of ____________ , 20 ______ . ________________________ Signature Unconditional Waiver and Release upon Final Payment Page 2 of 2